Childhood Liver Cancer : Stages and Treatment

by National Cancer Institute

(Page 2 of 3)

Stages of Childhood Liver Cancer

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 or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

There are 2 staging systems for childhood liver cancer:

Postsurgical (after surgery) staging: The stage is based on the amount of tumor that remains after the patient has had surgery to look at or remove the tumor. Postsurgical staging is used for most childhood liver cancer.

Presurgical (before surgery) staging: The stage is based on where the tumor has spread within the four parts (quadrants) of the liver, as shown by imaging procedures such as MRI or CT. This staging system, called PRETEXT, may be used for childhood hepatoblastoma.

The following tests and procedures may be used in the staging process:

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.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound: 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.

Surgery: An operation will be done to look at or remove the tumor. Tissues removed during surgery will be checked by a pathologist.

The following stages are used after surgery:

Stage I

In stage I, all of the cancer was removed by surgery.

Stage II

In stage II, all of the cancer that can be seen without a microscope was removed by surgery. A small amount of cancer remains in the liver, but it can be seen only with a microscope or the tumor cells may have spilled into the abdomen during surgery.

Stage III

In stage III:

• the tumor cannot be removed by surgery; or
• cancer that can be seen without a microscope remains after surgery; or
• the cancer has spread to nearby lymph nodes.

Stage IV

In stage IV, the cancer has spread to other parts of the body.

The following stages are used for childhood hepatoblastoma before surgery:

PRETEXT Stage 1

In stage 1, the cancer is found in one quadrant of the liver.

PRETEXT Stage 2

In stage 2, cancer is found in two quadrants of the liver that are next to each other.

PRETEXT Stage 3

In stage 3, cancer is found in three quadrants of the liver that are next to each other or two quadrants that are not next to each other.

PRETEXT Stage 4

In stage 4, cancer is found in all four quadrants.

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.

Treatment Option Overview

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, a clinical trial should be considered for all children who have liver cancer. Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

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.

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.

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