Liver Cancer

General Information | Treatment Options | Resources

 

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Stage

There are different types of treatment for patients with childhood liver cancer.

Different types of treatments are available for children with liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with liver cancer should have their treatment planned by a team of doctors with expertise in treating this rare childhood cancer.

Your child's treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who specialize in certain areas of medicine and who have experience and expertise in treating children who have liver cancer. It is especially important to have a pediatric surgeon with experience in liver surgery. Other specialists may include the following:

  • Radiation oncologist.
  • Pediatric nurse specialist.
  • Rehabilitation specialist.
  • Psychologist.
  • Social worker.

Some cancer treatments cause side effects months or years after treatment has ended.

Some cancer treatments cause side effects that continue or appear months or years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include:

  • Physical problems.
  • Changes in mood, feelings, thinking, learning, or memory.
  • Second cancers (new types of cancer).

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Three types of standard treatment are used:

Surgery

When possible, the cancer is removed by surgery.

  • Partial hepatectomy: Removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with a small amount of normal tissue around it.
  • Total hepatectomy and liver transplant: Removal of the entire liver and replacement with a healthy liver from a donor. A liver transplant may be possible when cancer has not spread beyond the liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
  • Resection of metastases: Surgery to remove cancer that has spread outside of the liver, such as to nearby tissues, the lungs, or the brain.

Chemotherapy or radiation therapy is sometimes given before surgery, to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemoembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of regional chemotherapy used to treat childhood liver cancer. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

Treatment using more than one anticancer drug is called combination chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI Web site.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage I and II Childhood Liver Cancer

Treatment for stages I and II and PRETEXT stages 1, 2, and 3 hepatoblastoma may include the following:

  • Surgery to remove the tumor, followed by chemotherapy or watchful waiting (closely monitoring a patient's condition without giving any treatment until symptoms appear or change).
  • Chemotherapy to shrink the tumor, followed by surgery to remove the tumor.

Treatment for stage I and II hepatocellular carcinoma is usually surgery to remove the tumor, followed by combination chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I childhood liver cancer and stage II childhood liver cancer.

Stage III Childhood Liver Cancer

Treatment of stage III and PRETEXT stage 4 hepatoblastoma may include the following:

  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.
  • If the tumor cannot be removed by surgery after chemotherapy, further treatment may include the following:
    • High-dose chemotherapy.
    • Radiation therapy.
    • Chemoembolization of the hepatic artery.
    • Liver transplant.
  • A clinical trial of combination chemotherapy.

Treatment of stage III hepatocellular carcinoma is usually combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III childhood liver cancer.

Stage IV Childhood Liver Cancer

Treatment of stage IV hepatoblastoma may include the following:

  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the cancer as possible, including cancer that has spread to the lungs. If the cancer is completely removed, additional chemotherapy is given to kill any cancer cells that may remain.
  • If the tumor cannot be removed by surgery after chemotherapy, further treatment may include the following:
    • High-dose chemotherapy.
    • Radiation therapy followed by surgery to remove as much of the tumor as possible.
    • Chemoembolization of the hepatic artery.
    • Liver transplant.
  • A clinical trial of chemotherapy.

Treatment of stage IV hepatocellular carcinoma may be combination chemotherapy to reduce the size of the tumor, followed by surgery to remove as much of the tumor as possible.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV childhood liver cancer.

Treatment Options for Recurrent Childhood Liver Cancer

Treatment of recurrent hepatoblastoma is usually surgery to remove isolated (single and separate) metastatic tumors.

Treatment in a clinical trial should be considered for recurrent hepatocellular carcinoma.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood liver cancer.

Cancer information from the NCI PDQ service