Treatments for Hepatocellular Carcinoma in Children

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What are the treatments for hepatocellular carcinoma?

Specific treatment for hepatocellular carcinoma will be determined by your child's physician based on some or all of the following factors:

  • 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

Treatment for hepatocellular carcinoma is generally aimed at resecting (removing) as much of the tumor as possible while making sure your child still has adequate liver function. Liver tissue can regenerate when removed.

Here are some of the methods of treatment employed by Boston Children's:

  • Surgery— Surgery is the key treatment of children with hepatocellular carcinoma.
    • Unfortunately, successful removal of the tumor or tumors is difficult in children with hepatocellular carcinoma for several reasons.

    • The disease may be present at multiple sites within the liver.

    • Underlying cirrhosis or scarring within the liver can make tumor removal much more difficult, and underlying metabolic problems with the liver make decrease your child's liver function even after surgery.

    • Keep in mind, however, that the liver has a remarkable capacity to regenerate.

    • Long-term follow-up studies of children have shown that the liver can continue to grow and often remains very close to what would be the predicted normal size of the liver despite removal of up to 2/3 of the liver in infancy.

    • Long-term follow-up studies of children have shown that the liver can continue to grow and often remains very close to what would be the predicted normal size of the liver despite removal of up to 2/3 of the liver in infancy.

  • Chemotherapy— As mentioned above, chemotherapy is a treatment used in conjunction with surgery and other treatments. Chemotherapy is a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce.

    • While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells.

    • Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.

    • Chemotherapy is introduced into the bloodstream and then travels throughout the body to kill cancer cells.

    • Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.

    • Often, a combination of chemotherapy drugs is used.

    • Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.

    • Chemotherapy can be given:

      • as a pill to swallow
      • as an injection into the muscle or fat tissue
      • intravenously (directly to the bloodstream)
      • intrathecally (directly into the spinal column with a needle)
  • Radiation therapy — Using high-energy rays from a specialized machine to damage or kill cancer cells and shrink tumors.

  • Liver transplant — Your child's liver may be replaced with a liver from a donor. Your child's physician will provide more information on whether this is an option for your child and the process involved.

  • Supportive care — Any type of treatment to prevent and treat infections, side effects of treatments, and complications, and to keep your child comfortable during treatment.

Continual follow-up care — A schedule of follow-up care determined by your child's physician and other members of your care team to monitor your child's ongoing response to treatment as well as possible late effects of treatment.

What is the long-term outlook for patients with hepatocellular carcinoma?

Your child's prognosis greatly depends on:

  • 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

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.

Continual follow-up care is essential for your child. New methods are continually being discovered to improve treatment and to decrease side effects of treatment.

What is the recommended long-term care for children treated for hepatocellular carcinoma?

Your child should visit a survivorship clinic every year to:

  • manage disease complications.
  • screen for early recurrence of cancer.
  • manage late effects of treatment.

A typical follow-up visit may include some or all of the following:

  • a physical exam
  • laboratory testing
  • imaging scans

Through the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute, childhood cancer survivors receive a comprehensive follow-up evaluation from their cancer care team.

  • Our childhood cancer survivorship clinic is held weekly.

  • In addition to meeting with your pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists or alternative/complementary therapy specialists.

  • We also offer the following services:

    • patient and family education
    • psychosocial assessment
    • genetic counseling
    • reproductive and fertility evaluation and counseling
    • opportunities to speak with other childhood cancer survivors
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- Sandra L. Fenwick, President and CEO

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