Testing & Diagnosis for Hepatocellular Carcinoma in Children

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How is hepatocellular carcinoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for hepatocellular carcinoma may include:

  • Biopsy - A sample of tissue removed from the tumor and examined under a microscope; your child’s 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 your child’s blood.

  • Additional blood tests - Blood chemistries, evaluation of liver and kidney functions, and genetic studies

  • Alpha-fetoprotein (AFP) test - Alpha-fetoprotein (AFP) levels in the blood can be used to diagnose and follow your child’s response to treatment.

  • Multiple imaging studies, including:

    • X-ray - A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film.

    • Computerized tomography scan (also called a CT or CAT scan) - 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.

    • Ultrasound (also called sonography) - 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 after a dye has been injected that is absorbed by liver tissue. These are used to detect tumors and liver abnormalities.

How do we know how far my child’s cancer has progressed?

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 hepatocellular carcinoma is the following: One of the most recently developed and widespread staging classifications for hepatocellular carcinoma is called the TNM (tumor-node-metastasis) system.

In this system, the size or extent of the primary tumor, its degree of spread to the lymph nodes and the presence of metastasis are all factors when determining stage.

Other parameters, such as the grade of differentiation between cancer cells and normal cells, may also be considered. The algorithm is complex, and you should always speak with your physician to learn exactly how the stage was determined. In general, staging places the cancer along a spectrum from isolated and operable on one end to metastasized and wholly or partly inoperable on the other end. 

  • Stage I — Usually a tumor that can be completely removed with surgery

  • Stage II — Usually a tumor that can mostly be removed by surgery; very small amounts of the cancer are left in the liver

  • Stage III — Usually a tumor that cannot be completely removed; cancer cells are also found in the lymph nodes

  • Stage IV — Cancer that has spread 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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