KidsMD Health Topics

Hepatocellular Carcinoma

  • Hepatocellular carcinoma is a rare disease in which cancerous cells are found in the tissues of your child’s liver. Although rare, it is the most common primary cancer of the liver.

    • This type of cancer is found in children from infants to birth to 19 year-old teenagers of age, but usually does not occur before the a child reaches age of 15.

    • The median age for diagnosis is 12 years old.

    • Hepatocellular carcinoma may occur in multiple places within your child’s liver.

    • Cancer cells can also spread (metastasize) to other areas of your child’s body.

    • The most common sites of metastasis are the lungs and the abdomen.

    Pioneering research

    Dana-Farber/Boston Children’s Cancer and Blood Disorders Center are conducting numerous research studies that will help clinicians better understand and treat hepatocellular carcinoma.

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 5
    Boston MA 02115

     617-355-5837
     fax: 617-730-0716

  • What causes hepatocellular carcinoma?

    Liver cancer is more common in children who have an underlying abnormality or condition, including the following:

    Children who are exposed to hepatitis B or C infections at an early age are at increased risk for developing hepatocellular carcinoma.

    What are the symptoms of hepatocellular carcinoma?

    Each child may experience symptoms differently, and symptoms may vary depending on the size of the tumor and whether the tumor has spread.

    Your child’s symptoms may include:

    • 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

    The symptoms of hepatocellular carcinoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

  • 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.

  • 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
  • What is the latest research on hepatoblastoma?

    Dana-Farber/Boston Children’s Cancer and Blood Disorders Center are conductsing numerous research studies that will help clinicians better understand and treat cancers, such as hepatocellular carcinoma.

    We participate in the current treatment protocols of the national Pediatric Oncology Group/Children's Oncology Group.

    Other types of treatments currently being studied include:

    • Biological therapies — A 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.

    For an overview of cancer-related treatment and research at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, click here.

    Treating hepatitis in children

    As discussed above a hepatitis B infection in childhood makes your child more susceptible to hepatocellular tumors.

    Maureen M. Jonas, MD, medical director of the Children’s Liver Transplant Program, has led research focused on liver disease in children with emphasis on viral hepatitis.

    She was the principal investigator in several international trials where to test drugs that that are effective in treating adults with chronic hepatitis B were ontested in children.

    Dr. Jonas's work has been published in the New England Journal of Medicine, Hepatology, Pediatric Infectious Disease Journal and other major medical journals.

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