Childhood Liver Cancer: Comprehensive Cancer Information

Childhood Liver Cancer: A Comprehensive Guide

General Information

Liver cancer in children is rare. According to authoritative health organisations, approximately 2% of cancers diagnosed in children are liver cancers. About 100 children each year are diagnosed with hepatoblastoma, which is the most common type of liver cancer found in the paediatric population.

The Liver's Function

The liver is the largest organ in the body, shaped like a pyramid and located under the right ribs. It consists of two sections, or lobes. The liver is unique among organs as it receives blood from two sources: the hepatic artery, which provides oxygen-rich blood, and the portal vein, which supplies nutrient-rich blood from the intestines.

Some of the vital functions performed by the liver include:

  • Breaking down and storing nutrients absorbed from the intestine.
  • Producing clotting factors essential to help the body stop bleeding.
  • Creating bile to assist the intestine in nutrient absorption.
  • Aiding the body in eliminating waste products.

If liver cancer spreads, the areas most likely to be affected are surrounding tissues, the lungs, or the brain.

Types of Paediatric Liver Cancer

Hepatoblastoma

This is the most common form of liver cancer in children and occurs most often in infants or very young children, typically between 2 months and 3 years of age.

Hepatocellular Carcinoma (HCC)

This type is more frequently seen in older children, generally between 10 and 16 years of age.

If your child has been diagnosed with liver cancer, SSCHRC is here to help.

Childhood Liver Cancer Risk Factors

A risk factor is anything that increases a child's chance of developing liver cancer. These factors include:

  • Certain conditions passed down genetically, such as Beckwith-Wiedemann syndrome and Familial adenomatous polyposis.
  • A low birth weight (defined as less than 3½ pounds).
  • A prior hepatitis infection.

It is important to understand that having risk factors does not guarantee that a child will develop liver cancer. If your child has any of these factors, it is essential to discuss them with their doctor.

Symptoms

Detecting liver cancer early significantly increases the chances of successful treatment. Symptoms can vary among children, and often, liver cancer may only present as a painless mass or bump in the abdomen with no other initial symptoms. In many cases, the cancer is discovered during a routine medical examination or by a parent.

Occasionally, paediatric liver cancer may have other accompanying signs, which can include:

  • Weight loss
  • Loss of appetite
  • Vomiting
  • Stomach pain
  • Anaemia
  • Jaundice (yellowing of the skin and eyes)
  • Unequal growth of one part of the body compared to another
  • Early signs of puberty

As liver cancer is rare, these symptoms usually point to other, less serious health problems. However, it is vital to discuss any symptoms with your doctor, as they may signal an underlying health issue.

Diagnosis

SSCHRC has the most up-to-date technology and advanced expertise to accurately diagnose paediatric liver cancer.

Our specialised pathologists are highly experienced in accurately pinpointing the disease, which is crucial as it increases the likelihood of successful treatment. They have access to the most detailed imaging tools, including precise triple-phase CT scans.

Diagnostic Tests

If your doctor is concerned that your child may have liver cancer, the initial step is a thorough physical examination. The doctor will also inquire about your child's health history and your family medical history.

One or more of the following tests may be used to confirm if your child has liver cancer, determine if it has spread, and monitor the effectiveness of treatment:

Blood tests

Including checking for elevated levels of alpha-fetoprotein (AFP), which can be a marker for liver cancer.

Imaging tests

These may include:

  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • Ultrasound
  • X-ray
  • Angiogram, which uses X-rays to make the liver's blood vessels visible.

Biopsy

A small sample of tissue from the tumour or the healthy part of the liver is removed and examined under a microscope. Healthy tissue may also be tested to check how well the liver is functioning. A biopsy may be performed using:

  • Fine Needle Aspiration (FNA): A thin needle is inserted into the liver to remove a small amount of tissue.
  • Core biopsy: Similar to FNA, but a thicker needle is used to remove small, cylinder-shaped samples (cores).
  • Laparoscopy: A small incision is made in the abdomen, and a thin, lighted tube (laparoscope) is inserted to view the tumour and remove a small tissue sample.
  • Surgical biopsy: Tissue is removed during an open operation.

Treatment

Your child's treatment will be meticulously planned by a team of doctors. They will discuss the optimal treatment approach, which may depend on:

  • Whether the tumour can be completely removed by surgery.
  • The type of cells present in the tumour.
  • Whether the cancer has spread.
  • The level of alpha-fetoprotein (AFP) in the tumour.

Hepatoblastoma and hepatocellular carcinoma (HCC) are treated differently. For treatment to be successful, both require complete surgical removal of the tumour. Hepatoblastoma typically responds well to chemotherapy, but HCC tumours are usually treated with surgery alone.

Surgery

Surgery is almost always an essential part of the treatment for paediatric liver cancer. If all or most of the cancer can be removed surgically, the possibility of a successful outcome is better.

If the tumour is too large or has spread to other parts of the liver or body, the surgeon may not be able to remove all of it. In this case, the surgeon will remove as much of the tumour as possible while preserving enough healthy liver tissue for the organ to function. Bleeding after surgery can be a concern since the liver aids in blood clotting. Furthermore, the cancer may recur if the remaining liver tissue is damaged.

The main types of surgery for liver cancer include:

  • Liver transplant: The entire diseased liver is surgically removed and replaced with a healthy donor organ. A liver transplant carries the risk of serious infection and other health issues.
  • Partial hepatectomy: The section of the liver where the tumour is located is surgically removed.
  • Tumour ablation: Heat (radiofrequency ablation) or extreme cold (cryosurgery or cryotherapy) is used to freeze or burn away the liver cancer. Ablation may be used when surgical removal of the tumour is not feasible.

Embolization

Tiny pellets made of plastic or another material are injected into the arteries that carry blood to the tumour. The pellets block the blood flow, making it difficult for the liver cancer to grow.

Radiation Therapy

Because radiation therapy can destroy normal liver tissue in addition to cancer cells, it can only be used in low doses for liver cancer. Radiation therapy cannot cure liver cancer, but it may be used to shrink the tumour or provide pain relief.

New radiation therapy techniques and the exceptional skill of SSCHRC doctors allow for more precise targeting of tumours, delivering the maximum amount of radiation with the least damage to healthy cells.

Chemotherapy

Chemotherapy is frequently used to treat hepatoblastoma, but hepatocellular carcinoma does not respond to it. Our experts are also developing new methods to deliver chemotherapy drugs directly into the liver, which allows for higher doses of drugs than is usually possible, with fewer side effects. These include:

  • Chemoembolization: A needle is inserted into an artery in the groin, and a tiny tube is threaded into an artery leading to the liver. A high dose of medicine is then administered. Following this, the artery is blocked to prevent it from feeding blood to the liver.
  • Hepatic artery infusion: A catheter (tube) is surgically placed in the liver. Drugs are continuously delivered through a special implanted pump.

Targeted Therapies

SSCHRC is one of only a few cancer centres in the nation that can offer targeted therapies for some types of paediatric liver cancer. These innovative new drugs halt the growth of cancer cells by interfering with the proteins, receptors, or blood vessels that supply the tumour with the resources it requires to grow.

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