Is Liver Cancer in a Child Curable?

Liver cancer occurs when cells in the liver grow out of control. The liver functions to filter harmful substances from the blood, to make bile to help digest fats from food, and to store glycogen (sugar), so the body can use it for energy.

Liver cancer in children and adolescents is rare. There are two main types of childhood liver cancer:

• Hepatoblastoma
  • The most common type of childhood liver cancer
  • Usually affects children under 3 years of age
• Hepatocellular carcinoma
  • Usually affects older children and adolescents
  • More common in parts of Asia with high rates of hepatitis B infection than in the U.S.

Less common types of childhood liver cancer include:

• Undifferentiated embryonal sarcoma of the liver
  • Usually affects children between 5 and 10 years of age and spreads through the liver and/or to the lungs
• Infantile choriocarcinoma of the liver
  • Very rare tumor that starts in the placenta and spreads to the fetus, usually found during the first few months of life
• Vascular liver tumors
  • Forms in the liver from cells that make blood vessels or lymph vessels and may be benign (not cancer) or malignant (cancer)

Symptoms of liver cancer in children become more common once the tumor becomes larger, and may include: 

• Lump in the abdomen that may be painful
• Swelling in the abdomen
• Weight loss with no known reason
• Loss of appetite
• Nausea 
• Vomiting

The exact cause of liver cancer in children is unknown. 

Risk factors for developing hepatoblastoma include:

• Being male 
• A very low birth weight 
• Aicardi syndrome
• Beckwith-Wiedemann syndrome
• Hemihyperplasia
• Familial adenomatous polyposis (FAP)
• Glycogen storage disease
• Simpson-Golabi-Behmel syndrome
• Certain genetic changes, such as trisomy 18

Risk factors for developing hepatocellular carcinoma include:

• Being male 
• Alagille syndrome
• Glycogen storage disease
• Hepatitis B or hepatitis C virus infection, especially when passed from mother to child at birth
• Progressive familial intrahepatic disease
• Tyrosinemia
• Biliary cirrhosis 

In addition to a physical exam and patient history, tests used to diagnose liver cancer in children include: 

• Blood tests 
  • Serum tumor marker test 
  • Complete blood count (CBC)
  • Liver function tests    
  • Blood chemistry studies
  • Epstein-Barr virus (EBV) test
  • Hepatitis assay
• Imaging tests
  • Magnetic resonance imaging (MRI) with gadolinium, also called nuclear magnetic resonance imaging (NMRI)
  • Computerized tomography (CT) scan 
  • Ultrasound 
  • Abdominal X-ray
• Biopsy
  • Immunohistochemistry

Treatment for pediatric liver cancer may include one or more of the following:

• Watchful waiting
  • Doctors closely monitor the patient’s condition and do not administer treatment unless signs and symptoms change
• Surgery 
  • Surgical removal of the cancer when possible
  • Partial hepatectomy: removal of the part of the liver where the cancer is found, along with a small amount of healthy tissue around it 
  • Total hepatectomy and liver transplant: removal of the entire liver followed by a transplant of a healthy liver from a donor    
  • Resection of metastases: surgical removal of cancer that has spread outside of the liver, such as to nearby tissues, the lungs, or the brain 
  • Chemotherapy may be given before surgery to shrink the tumor and make it easier to remove (neoadjuvant therapy)
  • Childhood liver cancer may be cured in some cases if the tumor is small and can be completely removed by surgery, which is possible more often for hepatoblastoma than for hepatocellular carcinoma
• Chemotherapy
  • Chemoembolization of the main artery that supplies blood to the liver (hepatic artery) may be used to treat childhood liver cancer that cannot be removed by surgery
• Radiation therapy
  • External radiation 
  • Internal radiation therapy
  • Radioembolization of the hepatic artery may be used to treat hepatocellular carcinoma
• Ablation therapy to remove or destroy tissue
  • Radiofrequency ablation    
  • Percutaneous ethanol injection
• Antiviral treatment
  • Hepatocellular carcinoma associated with hepatitis B virus may be treated with antiviral drugs
• Clinical trials
  • New treatments being studied
  • Targeted therapy
  • Tyrosine kinase inhibitors (TKIs) such as sorafenib and pazopanib for hepatocellular carcinoma that has come back after treatment and newly diagnosed undifferentiated embryonal sarcoma of the liver