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Liver Cancer (Childhood) General Information What is childhood liver cancer? Childhood liver cancer, also called hepatoma, is a rare disease in which cancer (malignant) cells are found in the tissues of your child's liver. The liver is one of the largest organs in the body, filling the upper right side of the abdomen and protected by the rib cage. The liver has many functions. It plays an important role in changing food into energy and also filters and stores blood. Primary liver cancer is different from cancer that has spread from another place in the body to the liver (liver metastases). (Refer to Adult Primary Liver Cancer Treatment for more information.) There are two types of cancer that start in the liver (hepatoblastoma and hepatocellular cancer), based on how the cancer cells look under a microscope. Hepatoblastoma is more common in young children before age 3 and may be caused by an abnormal gene. Children of families whose members carry a gene related to a certain kind of colon cancer may be more likely to develop hepatoblastoma (genes carry the hereditary information that you get from your parents). Children infected with hepatitis B or C (viral infections of the liver) are more likely than other children to get hepatocellular cancer. Immunization to prevent hepatitis B may decrease the chance of developing hepatocellular cancer. Hepatocellular cancer is found in children from birth to 19 years of age. If your child has symptoms, your child's doctor may order special x-rays, such as a CT scan or a liver scan. If a lump is seen on an x-ray, your child's doctor may remove a small amount of tissue from the liver using a needle inserted into the abdomen. This is called a needle biopsy and is usually done using an x-ray to guide the doctor. Your child's doctor will have the tissue looked at under the microscope to see if there are any cancer cells. Your child's chance of recovery (prognosis) and choice of treatment depend on the stage of your child's cancer (whether it is just in the liver or has spread to other places), how the cancer cells look under a microscope (the histology), and your child's general state of health. Stage Information Stages of childhood liver cancer: Once liver cancer is found, more tests will be done to find out if the cancer cells have spread to other parts of the body. This is called staging. Your child's doctor needs to know the stage of disease in order to plan treatment. The following stages are used for childhood liver cancer: Stage I Stage I childhood liver cancer means the cancer can be removed with surgery. Stage II Stage II childhood liver cancer means that most of the cancer may be removed in an operation but very small (microscopic) amounts of cancer are left in the liver following surgery. Stage III Stage III childhood liver cancer means that some of the cancer may be removed in an operation, but some of the tumor cannot be removed and remains either in the abdomen or in the lymph nodes. Stage IV Stage IV childhood liver cancer means the cancer has spread to other parts of the body. Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the liver or in another part of the body. Treatment Option Overview How childhood liver cancer is treated: There are treatments for all children with liver cancer. Four kinds of treatment are used: -surgery (taking out the cancer in an operation) -chemotherapy (using drugs to kill cancer cells). -radiation therapy (using high-dose x-rays to kill cancer cells) -liver transplantation (replacing the liver with a donated liver) Surgery may be used to take out the cancer and part of the liver where the cancer is found. Sometimes the entire liver may be surgically removed and replaced by a liver transplant from a donor. Surgery may also be used to remove cancer that may spread to other parts of the body such as to the tissues surrounding the liver, to the lungs, or to the brain. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be given to your child before surgery to help reduce the size of the liver cancer. Your child may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy given after surgery when the doctor has removed the cancer is called adjuvant chemotherapy. Chemotherapy for childhood liver cancer is usually put into the body through a needle in a vein or artery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. In another type of chemotherapy, called direct infusion chemotherapy, drugs are injected directly into the blood vessels that go into the liver. Sometimes a special treatment called chemo-embolization is used to treat childhood liver cancer. Chemotherapy drugs are injected into the main artery of the liver with substances that block or slow the flow of blood into the cancer. This lengthens the time the drugs have to kill the cancer cells and it also prevents the cancer cells from getting oxygen or other materials that they need to grow. Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). If surgery to remove the tumor is not possible, your child may undergo liver transplantation to replace the diseased liver with a healthy one from a donor. Treatment By Stage Treatments for childhood liver cancer depend on the type (hepatoblastoma or hepatocellular carcinoma) and stage of your child's disease and your child's age and general health. Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child take part in a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are ongoing in many parts of the country for most stages of childhood liver cancer. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. Stage I and II Childhood Liver Cancer Stage I and II Hepatoblastoma Your child's treatment will probably be complete removal of the liver cancer by surgery followed by adjuvant chemotherapy. Stage I and II Hepatocellular Carcinoma Your child's treatment will probably be complete removal of the liver cancer by surgery followed by adjuvant chemotherapy. Stage III Childhood Liver Cancer Stage III Hepatoblastoma Your child's treatment may be one or more of the following: 1. Chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible. 2.Radiation therapy. 3.Direct infusion of drugs into blood vessels going into the liver. 4.Liver transplant: Surgical removal of the liver followed by replacement with a donor's liver. Stage III Hepatocellular Carcinoma Your child's treatment will probably be chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible. (Refer to Adult Primary Liver Cancer Treatment for more information.) Stage IV Childhood Liver Cancer Stage IV Hepatoblastoma Your child's treatment may be one or more of the following: 1. Chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible followed by chemotherapy. 2. Surgical removal of cancer that has spread to the lungs. 3. Chemotherapy. 4. Radiation therapy followed by additional surgery. 5. Direct infusion of chemotherapy drugs into blood vessels going into the liver. 6. Chemotherapy drugs injected into the main liver artery with substances that block or slow the flow of blood (chemo-embolization chemotherapy). 7. Liver transplant: Surgical removal of the liver followed by replacement with a donor's liver. 8. Clinical trials are testing new therapies and may be considered for your child. Stage IV Hepatocellular Carcinoma Your child's treatment will probably be chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible. (Refer to Adult Primary Liver Cancer Treatment for more information.) Recurrent Childhood Liver Cancer Recurrent Hepatoblastoma Treatment depends on where the cancer recurred and how the cancer was treated before. Treatment may include additional surgery. Clinical trials are testing new therapies and may be considered for your child. Recurrent Hepatocellular Carcinoma Clinical trials are testing new therapies and may be considered for your child. (Refer to Adult Primary Liver Cancer Treatment for more information.) The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals. The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation. The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. 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