Childhood Liver Cancer Treatment
General Information(Symptoms and Diagnosis)
Stages
Treatment
General Information About Childhood Liver Cancer
Key Points
- Childhood liver cancer is a disease in which malignant
(cancer) cells form in the tissues of the liver.
- There are different types of childhood liver cancer.
- Certain diseases and disorders can increase the risk of
childhood liver cancer.
- Signs and symptoms of childhood liver cancer include a lump
or pain in the abdomen.
- Tests that examine the liver and the blood are used to
detect (find) and diagnose childhood liver cancer and find out whether
the cancer has spread.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Childhood
liver cancer is a disease in which malignant (cancer) cells form in the
tissues of the liver.
The liver
is one of the largest organs
in the body. It has four lobes
and fills the upper right side of the abdomen
inside the rib cage. Three of the many important functions of the liver
are:
- To filter
harmful substances from the blood
so they can be passed from the body in stools
and urine.
- To make bile
to help digest
fats from food.
- To store glycogen (sugar), which the body uses for energy.
Anatomy of the liver. The
liver is in the upper abdomen near the stomach, intestines,
gallbladder, and pancreas. The liver has four lobes. Two lobes are on
the front and two small lobes (not shown) are on the back of the liver.
Liver
cancer is rare in children and adolescents.
There
are different types of childhood liver cancer.
There are two main types
of childhood liver
cancer:
The treatment of two
less common types of childhood liver cancer is also discussed in this
summary:
- Undifferentiated embryonal
sarcoma
of the liver: This type of liver cancer usually occurs in children
between 5 and 10 years of age. It often spreads all through the liver
and/or to the lungs.
- Infantile choriocarcinoma
of the liver is a very rare tumor
that starts in the placenta
and spreads to the fetus.
The tumor is usually found during the first few months of life. Also,
the mother of the child may be diagnosed
with choriocarcinoma. Choriocarcinoma is a type of gestational
trophoblastic disease and needs treatment. See the
Gestational
Trophoblastic Disease Treatment summary for information on
the treatment of choriocarcinoma.
Epithelioid
hemangioendothelioma is a rare cancer
of the blood
vessels that occurs in the liver and other organs. See the
Epithelioid
hemangioendothelioma section in the PDQ
summary on Childhood
Vascular Tumors Treatment for more information.
This summary is about
the treatment of primary
liver cancer (cancer that begins in the liver). Treatment of metastatic
liver cancer, which is cancer that begins in other parts of the body
and spreads to the liver, is not discussed in this summary. Primary
liver cancer can occur in both adults and children. However, treatment
for children is different than treatment for adults. See the PDQ
summary on Adult
Primary Liver Cancer Treatment for more information on the
treatment of adults.
Certain
diseases and disorders can increase the risk of childhood liver cancer.
Anything that increases
your chance of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get
cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your child's doctor if you think your child may be at
risk.
Risk factors for
hepatoblastoma include the following syndromes
or conditions:
- Aicardi
syndrome.
- Beckwith-Wiedemann
syndrome.
- Familial
adenomatous polyposis (FAP).
- Glycogen
storage disease.
- A very low weight at birth.
- Simpson-Golabi-Behmel syndrome.
- Certain genetic
changes, such as Trisomy
18.
Risk factors for
hepatocellular carcinoma include the following syndromes or conditions:
- Alagille
syndrome.
- Glycogen
storage disease.
- Hepatitis
B virus infection that was passed from mother to child at
birth.
- Progressive
familial intrahepatic disease.
- Tyrosinemia.
Some patients with
tyrosinemia or progressive familial intrahepatic disease will have a
liver transplant
before there are signs
or symptoms
of cancer.
Signs
and symptoms of childhood liver cancer include a lump or pain in the
abdomen.
Signs and symptoms are
more common after the tumor gets big. Other conditions can cause the
same signs and symptoms. Check with your child's doctor if your child
has any of the following:
- A lump in the abdomen
that may be painful.
- Swelling in the abdomen.
- Weight loss for no known reason.
- Loss of appetite.
- Nausea
and vomiting.
Tests
that examine the liver and the blood are used to detect (find) and
diagnose childhood liver cancer and find out whether the cancer has
spread.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Serum
tumor marker test : A procedure in which a
blood sample is checked to measure the amounts of certain substances
released into the blood by organs, tissues,
or tumor cells in the body. Certain substances are linked to specific
types of cancer when found in increased levels in the blood. These are
called tumor
markers. The blood of children who have liver cancer may
have
increased amounts of a hormone
called beta-human
chorionic gonadotropin (ß-hCG) or a protein
called alpha-fetoprotein
(AFP). Other cancers and certain noncancer conditions, including cirrhosis
and hepatitis,
can also increase AFP levels.
- Complete
blood count (CBC): A procedure in which a
sample of blood is drawn and checked for the following:
- The number of red
blood cells, white
blood cells, and platelets.
- The amount of hemoglobin
(the protein that carries oxygen)
in the red blood cells.
- The portion of the blood sample made up of red blood
cells.
- Liver
function tests : A procedure in which a
blood
sample is checked to measure the amounts of certain substances released
into the blood by the liver. A higher than normal amount of a substance
can be a sign of liver damage or cancer.
- Blood
chemistry studies : A procedure in which a
blood sample is checked to measure the amounts of certain substances,
such as bilirubin
or lactate
dehydrogenase (LDH), released into the blood by organs and
tissues in the body. An unusual (higher or lower than normal) amount of
a substance can be a sign of disease.
- Epstein-Barr
virus (EBV) test: A blood
test to check for antibodies
to the EBV and DNA
markers
of the EBV. These are found in the blood of patients who have been
infected with EBV.
- Hepatitis assay
: A procedure in which a blood sample is checked for
pieces of the hepatitis virus.
- MRI
(magnetic resonance imaging) with gadolinium
: A procedure that uses a magnet, radio
waves, and a computer to make a series of detailed
pictures
of areas inside the liver. A substance called gadolinium is injected
into a vein.
The gadolinium collects around the cancer cells so they show up
brighter in the picture. This procedure is also called nuclear magnetic
resonance imaging (NMRI).
Magnetic resonance
imaging (MRI) of the abdomen. The child lies on a table that slides
into the MRI scanner, which takes pictures of the inside of the body.
The pad on the child's abdomen helps make the pictures clearer.
- Ultrasound
exam: A procedure in which high-energy sound waves
(ultrasound) are bounced off internal tissues or organs and make
echoes. The echoes form a picture of body tissues called a sonogram.
The picture can be printed to be looked at later. In childhood liver
cancer, an ultrasound exam of the abdomen to check the large blood
vessels is usually done.
Abdominal ultrasound.
An ultrasound transducer connected to a computer is pressed against the
skin of the abdomen. The transducer bounces sound waves off internal
organs and tissues to make echoes that form a sonogram (computer
picture).
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, taken from
different angles. The pictures are made by a computer linked to an x-ray
machine. A dye
may be injected
into a vein or swallowed to help the organs or tissues show up more
clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography. In childhood
liver cancer, a CT scan of the chest and abdomen is usually done.
Computed tomography
(CT) scan of the abdomen. The child lies on a table that slides through
the CT scanner, which takes x-ray pictures of the inside of the abdomen.
- Abdominal
x-ray
: An x-ray of the organs in the abdomen. An x-ray is
a type of energy beam that can go through the body onto film, making a
picture of areas inside the body.
- Biopsy
: The removal of a sample of cells or tissues so it
can be viewed under a microscope
to check for signs of cancer. The sample may be taken during surgery
to remove or view the tumor. A pathologist
looks at the sample under a microscope to find out the type of liver
cancer.
The following test
may be done on the sample of tissue that is removed:
- Immunohistochemistry
: A test that uses antibodies
to check for certain antigens
in a sample of tissue. The antibody is usually linked to a radioactive
substance or a dye that causes the tissue to light up under a
microscope. This type of test is used to check for a certain gene
mutation
and to tell the difference between different types of cancer.
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis
(chance of recovery)
and treatment options for hepatoblastoma depend on the following:
- The PRETEXT
or POSTTEXT group.
- Whether the cancer has spread to other places in the body,
such as the lungs
or certain large blood
vessels.
- Whether the cancer can be removed completely by surgery.
- How the cancer responds to chemotherapy.
- How the cancer cells look under a microscope.
- Whether the AFP blood levels go down after treatment.
- Whether the cancer has just been diagnosed
or has recurred.
- Age of the child.
The prognosis (chance of
recovery) and treatment options for hepatocellular carcinoma depend on
the following:
- The PRETEXT
or POSTTEXT group.
- Whether the cancer has spread to other places in the body,
such as the lungs.
- Whether the cancer can be removed completely by surgery.
- How the cancer responds to chemotherapy.
- How the cancer cells look under a microscope.
- Whether the child has hepatitis B infection.
- Whether the cancer has just been diagnosed or has recurred.
For childhood liver
cancer that recurs (comes back) after initial treatment, the prognosis
and treatment options depend on:
- Where in the body the tumor recurred.
- The type of treatment used to treat the initial cancer.
Childhood liver cancer
may be cured
if the tumor is small and can be completely removed by surgery.
Complete removal is possible more often for hepatoblastoma than for
hepatocellular carcinoma.
Stages of Childhood Liver Cancer
Key Points
- After childhood liver cancer has been diagnosed, tests are
done to find out if cancer cells have spread within the liver or to
other parts of the body.
- There are two grouping systems for childhood liver cancer.
- There are four PRETEXT and POSTTEXT groups:
- PRETEXT and POSTTEXT Group I
- PRETEXT and POSTTEXT Group II
- PRETEXT and POSTTEXT Group III
- PRETEXT and POSTTEXT Group IV
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
After
childhood liver cancer has been diagnosed, tests are done to find out
if cancer cells have spread within the liver or to other parts of the
body.
The process used to find
out if cancer
has spread within the liver,
to nearby tissues
or organs,
or to other
parts of the body is called staging.
In childhood liver
cancer, the PRETEXT and POSTTEXT groups are used instead
of
stage to plan treatment. The results of the tests
and procedures done to detect, diagnose,
and find out whether the cancer has spread are used to determine the
PRETEXT and POSTTEXT groups.
There
are two grouping systems for childhood liver cancer.
Two grouping systems are
used for childhood liver
cancer:
- The PRETEXT group describes the tumor
before the patient has treatment.
- The POSTTEXT group describes the tumor after
the patient has treatment.
There
are four PRETEXT and POSTTEXT groups:
The liver is divided
into 4 sections. The PRETEXT and POSTTEXT groups depend on which
sections of the liver have cancer.
PRETEXT
and POSTTEXT Group I
Liver PRETEXT I. Cancer is
found in one section of the liver. Three sections of the liver that are
next to each other do not have cancer in them.
In group I, the cancer
is found in one section of the liver.
Three sections of the liver that are next to each other do not have
cancer in them.
PRETEXT
and POSTTEXT Group II
Liver PRETEXT II. Cancer is
found in one or two sections of the liver. Two sections of the liver
that are next to each other do not have cancer in them.
In group II, cancer
is found in one or two sections of the liver.
Two sections of the liver that are next to each other do not have
cancer in them.
PRETEXT
and POSTTEXT Group III
Liver PRETEXT III. Cancer
is found in three sections of the liver and one section does not have
cancer, or cancer is found in two sections of the liver and two
sections that are not next to each other do not have cancer in them.
In group III, one of the
following is true:
- Cancer
is found in three sections of the liver
and one section does not have cancer.
- Cancer is found in two sections of the liver and two
sections that are not next to each other do not have cancer in them.
PRETEXT
and POSTTEXT Group IV
Liver PRETEXT IV. Cancer is
found in all four sections of the liver.
In group IV, cancer
is found in all four sections of the liver.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue,
the lymph
system, and the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph
vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood
vessels to other parts of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells
break away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor
(metastatic
tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic
tumor is the same type of cancer as the primary
tumor. For example, if childhood liver cancer spreads to
the lung,
the cancer cells
in the lung are actually liver cancer cells. The disease is metastatic
liver cancer, not lung
cancer.
Recurrent Childhood Liver Cancer
Recurrent
childhood liver
cancer is cancer that has recurred (come back) after it
has
been treated. The cancer may come back in the liver
or in other parts of the body. Cancer that is growing or worsening
during treatment is progressive
disease.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
childhood liver cancer.
- Children with liver cancer should have their treatment
planned by a team of healthcare providers who are experts in treating
this rare childhood cancer.
- Some cancer treatments cause side effects months or years
after treatment has ended.
- Five types of standard treatment are used:
- Surgery
- Watchful waiting
- Chemotherapy
- Radiation therapy
- Antiviral treatment
- New types of treatment are being tested in clinical trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
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.
Taking part in a clinical
trial should be considered for all children with liver cancer. 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
healthcare providers who are experts in treating this rare childhood
cancer.
Treatment will be
overseen by a pediatric
oncologist, a doctor who specializes in treating children
with cancer. The pediatric oncologist works with other healthcare
providers who are experts in treating children with liver
cancer and who specialize in certain areas of medicine.
It is especially important to have a pediatric
surgeon with experience in liver
surgery
who can send patients to a liver transplant
program if needed. Other specialists
may include the following:
- Pediatrician.
- Radiation
oncologist.
- Pediatric
nurse specialist.
- Rehabilitation
specialist.
- Psychologist.
- Social
worker.
Some
cancer treatments cause side effects months or years after treatment
has ended.
Side
effects from cancer treatment that begin during or after
treatment and continue for months or years 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 effects cancer treatment can have on your child. (See
the PDQ
summary on Late
Effects of Treatment for Childhood Cancer for more
information).
Five
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 followed by a transplant of 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.
Factors that affect the
type of surgery used include the following:
- The PRETEXT group and POSTTEXT group.
- The size of the primary
tumor.
- Whether there is more than one tumor
in the liver.
- Whether the cancer has spread to nearby large blood
vessels.
- The level of alpha-fetoprotein
(AFP) in the blood.
- Whether the tumor can be shrunk by chemotherapy
so that it can be removed by surgery.
- Whether a liver transplant is needed.
Chemotherapy 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 or radiation
therapy after surgery to kill any cancer cells
that are left. Treatment given after the surgery, to lower the risk
that the cancer will come back, is called adjuvant
therapy.
Watchful
waiting
Watchful
waiting is closely monitoring
a patient's condition
without giving any treatment until signs
or symptoms
appear or change. In hepatoblastoma,
this treatment is only used for small tumors that have been completely
removed by surgery.
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 cerebrospinal
fluid, an organ,
or a body cavity
such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional
chemotherapy). Treatment using more than one anticancer
drug
is called combination
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.
This procedure is also called transarterial chemoembolization or TACE.
The way the chemotherapy
is given depends on the type of the cancer being treated and the
PRETEXT or POSTTEXT group.
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 of the cancer being treated and
the PRETEXT or POSTTEXT group. Radioembolization
of the hepatic artery (the main artery that supplies blood to the
liver) is a type of internal radiation therapy used to treat hepatocellular
carcinoma. A very small amount of a radioactive substance
is
attached to tiny beads that are injected into the hepatic artery
through a catheter (thin tube). The beads are mixed with a substance
that blocks the artery, cutting off blood flow to the tumor. Most of
the radiation is trapped near the tumor to kill the cancer cells. This
is done to relieve symptoms and improve quality
of life for children with hepatocellular carcinoma.
External
radiation therapy is used to treat hepatoblastoma that cannot be
removed by surgery or has spread to other parts of the body.
Antiviral
treatment
Hepatocellular carcinoma
that is linked to the hepatitis
B virus may be treated with antiviral
drugs.
New
types of treatment are being tested in clinical trials.
This summary section
describes treatments that are being studied in clinical
trials. It may not mention every new treatment being
studied.
Information about clinical trials is available from the NCI
website.
Targeted
therapy
Targeted
therapy is a type of treatment that uses drugs or other
substances to attack specific cancer cells. Targeted therapies usually
cause less harm to normal cells than chemotherapy or radiation therapy
do. Targeted therapy is being studied for the treatment of undifferentiated
embryonal
sarcoma
of the liver and liver cancer that has come back.
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
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests that
were done to diagnose
the cancer or to find out the treatment group 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.
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.
Treatment Options for Childhood Liver Cancer
Hepatoblastoma
Treatment options for hepatoblastoma that can be
removed by surgery
at the time of diagnosis
may include the following:
- Surgery
to remove the tumor,
followed by watchful waiting
or chemotherapy,
for hepatoblastoma with pure fetal
histology.
- Surgery to remove the tumor, with combination chemotherapy
given either before surgery, after surgery, or both, for hepatoblastoma
that is not pure fetal histology. For hepatoblastoma with small cell undifferentiated histology, aggressive chemotherapy is
given.
Treatment options for
hepatoblastoma that cannot be removed by surgery or is not removed at
the time of diagnosis may include the following:
- Combination chemotherapy to shrink the tumor, followed by
surgery to remove the tumor.
- Combination chemotherapy followed by a liver transplant.
- Chemoembolization
of the hepatic artery
to shrink the tumor, followed by surgery to remove the tumor.
For hepatoblastoma that
has spread to other parts of the body at the time of diagnosis,
combination chemotherapy is given to shrink the cancer in the liver and
cancer that has spread to other parts of the body. After chemotherapy, imaging tests are done to
check whether the cancer can be removed by surgery.
Treatment options may
include the following:
- If the cancer in the liver and other parts of the body can
be removed, surgery will be done to remove the tumors followed by
chemotherapy to kill any cancer cells that may remain.
- If the cancer in the liver cannot be removed by surgery but
there are no signs
of cancer in other parts of the body, the treatment may be a liver
transplant.
- If the cancer in other parts of the body cannot be removed
or a liver transplant is not possible, chemotherapy, chemoembolization
of the hepatic artery, or radiation
therapy may be given.
Treatment options in clinical trials for newly diagnosed hepatoblastoma
include:
- A clinical trial of new treatment regimens based on how likely
it is the cancer will recur
after initial treatment.
Hepatocellular Carcinoma
Treatment options for hepatocellular carcinoma
that can be removed by surgery
at the time of diagnosis
may include the following:
- Surgery alone to remove the tumor.
- Surgery to remove the tumor, followed by chemotherapy.
- Combination
chemotherapy followed by surgery to remove the tumor.
Treatment options for
hepatocellular carcinoma that cannot be removed by surgery at the time
of diagnosis may include the following:
- Chemotherapy to shrink the tumor, followed by surgery to
completely remove the tumor.
- Chemotherapy to shrink the tumor. If surgery to completely
remove the tumor is not possible, further treatment may include the
following:
- Liver
transplant.
- Chemoembolization of the hepatic
artery to shrink the tumor, followed by surgery to remove
as much of the tumor as possible or liver transplant.
- Chemoembolization of the hepatic artery alone.
- Radioembolization
of the hepatic artery as palliative
therapy to relieve symptoms
and improve the quality of life.
Treatment for
hepatocellular carcinoma that has spread to other parts of the body at
the time of diagnosis may include:
- Combination chemotherapy to shrink the tumor, followed by
surgery to remove as much of the tumor as possible from the liver and
other places where cancer has spread. Studies have not shown that this
treatment works well but some patients may have some benefit.
Treatment options for
hepatocellular carcinoma related to hepatitis
B virus (HBV) infection
include:
- Surgery to remove the tumor.
- Antiviral
drugs that treat
infection caused by the hepatitis B virus.
Undifferentiated Embryonal Sarcoma of
the Liver
Treatment options for undifferentiated embryonal sarcoma of the liver (UESL) may include the
following:
- Combination
chemotherapy to shrink the tumor,
followed by surgery
to remove as much of the tumor as possible. Chemotherapy
may also be given after surgery to remove the tumor.
- Surgery to remove the tumor followed by chemotherapy. A
second surgery may be done to remove tumor that remains, followed by
more chemotherapy.
- Liver transplant if surgery to
remove the tumor is not possible.
- A clinical trial
of a combination of targeted
therapy, chemotherapy and/or radiation
therapy before surgery.
Infantile Choriocarcinoma of the Liver
Treatment options for choriocarcinoma of the liver in infants may include
the following:
- Combination
chemotherapy to shrink the tumor,
followed by surgery
to remove the tumor.
- Surgery to remove the tumor.
Recurrent Childhood Liver Cancer
Treatment of recurrent hepatoblastoma may include
the following:
- Surgery
to remove isolated (single and separate) metastatic
tumors with or
without chemotherapy.
- Combination
chemotherapy.
- Liver transplant.
- A clinical trial
of a new treatment.
Treatment of progressive or recurrent hepatocellular carcinoma may
include the following:
- Chemoembolization
of the hepatic artery
to shrink the tumor before liver transplant.
- Liver transplant.
- A clinical trial of a new treatment.
-NIH
