 Hepatocellular Carcinoma
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Hepatocellular carcinoma is a rare disease in which cancerous cells are found in the tissues of the liver. This type of cancer is found in children from birth to 19 years of age, but usually does not occur before the age of 15. The median age is 12 years old.
Hepatocellular carcinoma may occur in multiple sites within the liver. Cancer cells can also spread (metastasize) to other areas of the body. The most common sites of metastasis are the lungs, into the abdomen and abdominal structures, and rarely to bone, the central nervous system, and the bone marrow.
As you read further below, you will find general information about hepatocellular carcinmoa. If you would like to view summary information about cancer first, see the cancer overview.
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Hepatocellular carcinoma may arise in livers which have an underlying abnormality including children with a prior history of biliary atresia and such metabolic abnormalities as tyrosinemia, galactosemia, familial cholestatic cirrhosis, giant cell hepatitis of infancy, Fanconi's anemia, glycogen storage disease, and anti-trypsin deficiency. Children who are exposed to hepatitis B or C infections at an early age are at increased risk for developing hepatocellular carcinoma. Some hepatocellular carcinomas have genetic alterations in tumor suppressor genes, which would explain the uncontrolled cell growth.
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The following are the most common symptoms of hepatocellular carcinoma. However, each child may experience symptoms differently. Symptoms may vary depending on the size of the tumor and the presence and location of metastases. Symptoms may include:
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- a large abdominal mass, or swollen abdomen
- pain on the right side that may extend into the back and shoulder
- weight loss, decreased appetite
- abdominal pain
- vomiting
- jaundice (yellowing of the eyes and skin)
- fever
- itching skin
- anemia (pale skin and lips from decreased number of red blood cells)
- back pain from compression of the tumor
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The symptoms of hepatocellular carcinoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
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In addition to a complete medical history and physical examination, diagnostic procedures for hepatocellular carcinoma may include:
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- biopsy - a sample of tissue removed from the tumor and examined under a microscope; the surgeon may also look at the liver using an instrument called a laparascope, a small tube with a light on the end
- complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood
- additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies
- multiple imaging studies, including:
- computerized tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body
- x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
- ultrasound (also called sonography) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- liver scans - pictures or x-rays taken of the liver after a dye has been injected that is absorbed by liver tissue. These are used to detect tumors and liver abnormalities.
- alpha-fetoprotein (AFP) test - alpha-fetoprotein (AFP) levels in the blood can be used to diagnose and follow response to treatment
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Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging symptoms that are used for hepatocellular carcinoma. Always consult your child's physician for information on staging. One method of staging is the following:
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- stage I - usually a tumor that can be completely removed with surgery
- stage II - usually a tumor that can mostly be removed by surgery but very small amounts of the cancer are left in the liver
- stage III - usually a tumor that cannot be completely removed and the cancer cells are found in the lymph nodes
- stage IV - cancer that has spread (metastasized) to other parts of the body
- recurrent - the disease has returned after it has been treated. It may come back in the liver or in another part of the body.
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Specific treatment for hepatocellular carcinoma will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures, and therapies
- how your child's physician expects the disease to progress
- your opinion or preference
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Treatment for hepatocellular carcinoma is generally aimed at resecting (removing) as much of the tumor as possible while maintaining adequate liver function. Liver tissue can regenerate when removed.
Other forms of treatment may include (alone or in combination):
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Prognosis greatly depends on:
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- the extent of the disease
- the size and location of the tumor
- presence or absence of metastasis
- the tumor's response to therapy
- the age and overall health of your child
- your child's tolerance of specific medications, procedures, or therapies
- new developments in treatment
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As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with hepatocellular carcinoma. New methods are continually being discovered to improve treatment and to decrease side effects.
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Children's Hospital and Dana-Farber Cancer Institute are conducting numerous research studies that will help clinicians better understand and treat hepatocellular carcinoma.
Other types of treatment currently being studied include:
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- biological therapies - a wide range of substances that may be able to involve the body's own immune system to fight cancer or lessen harmful side effects of some treatments
- new ways of delivering chemotherapy - researchers are studying new delivery strategies, such as putting chemotherapy directly into the liver
- cryotherapy - surgeons are studying new ways of using this existing treatment, which uses extreme cold to destroy unwanted tissue) for liver cancer
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