Childhood Liver Cancer : Treatment

by National Cancer Institute

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Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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. 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.

Other types of treatment are being tested in clinical trials.

Treatment Options by Stage

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.

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.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

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.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

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.

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