A Review of Treatment Options for Children with Liver Cancer

There are different types of therapies available for children with liver cancer.

There are different types of therapies available for children with liver cancer. Some are standard therapies (therapies that are in use) and some are still in clinical trials. Clinical trials are research topics designed to help enhance existing therapies or to get information about new therapies for people with cancer. A new therapy can become a standard therapy when clinical trials show that it is better than the standard therapy.

All children with liver cancer should be considered for a particular clinical trial. Some clinical trials are only open to patients who have not yet started treatment.

The treatment plan for children with liver cancer should be done by a panel of health care professionals who treat this rare childhood cancer.

Treatment will be done under the supervision of a pediatric oncologist, a doctor who specializes in treating children with cancer. This pediatric oncologist collaborates with other pediatric liver cancer treatment specialists and specialists in specific drug areas to provide health care services. It is especially important to work with a pediatric surgeon who has experience in liver surgery and who can transfer patients to a liver transplant program if needed. Other specialists may include the following:

Pediatrician.

Radiation oncologists.

Pediatric nurse specialist.

Rehabilitation specialists.

Psychologists.

Social worker.

Treatment for childhood liver cancer may cause side effects.

For information about side effects that start during cancer treatment, see our side effects page.

Side effects of cancer treatment that start after treatment and last 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.

Secondary cancers (new cancers)

Some late effects can be treated or managed. It is important to talk with your child’s doctor about the possible effects of cancer treatment on your child. (For more information, see the PDQ summary of late effects of childhood cancer treatment.)

The six standard therapies in use are:

Surgery

Surgery to remove the tumor if the situation allows.

Partial hepatectomy: A portion of the liver with cancer is removed. The portion removed may be a wedge of tissue, an entire lobe or a large portion of the liver, and a small amount of normal tissue adhering to the perihepatic area.

Total hepatectomy and liver transplantation: Removal of the entire liver followed by transplantation of a healthy liver from a donor. A liver transplant can be performed when the cancer has not spread beyond the liver and a donor liver can be found. If the patient must wait for a donor liver, other treatments may be available as needed.

Metastasectomy: Surgical removal of a tumor that has spread outside the liver (for example, surrounding tissue, lung, brain).

The type of surgery that can be performed depends on the following:

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 and surgically removed with chemotherapy.

Whether a liver transplant is needed.

Sometimes chemotherapy is given before surgery to shrink the tumor and make it easier to remove, called neoadjuvant therapy.

While doctors will remove all the cancer cells they can see during surgery, some patients may receive chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. The treatment given after surgery to reduce the risk of the cancer coming back is called adjuvant therapy.

Wait and watch

Wait and watch means that the patient is monitored closely and no treatment is given until signs or symptoms appear or change. In hepatoblastoma, this treatment is only indicated for small tumors that have been completely removed by surgery.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop (either by killing cancer cells or by stopping them from dividing) the growth of cancer cells. When chemotherapy is given orally or by injection into a vein or muscle, the drug enters the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When given directly into the cerebrospinal fluid, organs, or body cavities such as the abdomen, the drug primarily affects cancer cells in these areas (regional chemotherapy). Treatment with more than one anticancer drug is called combination chemotherapy.

Chemoembolization of the hepatic artery (the main artery supplying blood to the liver) is a form of regional chemotherapy used to treat childhood liver cancer that cannot be removed surgically. An anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug mixes with the material blocking the artery, cutting off the blood flow to the tumor. Most of the anti-cancer drug is trapped near the tumor, and only a small amount reaches other parts of the body. Depending on the substance used to block the artery, the blockage can be temporary or permanent. This prevents the tumor 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 intestines to the liver. This approach is also called transarterial chemoembolization or TACE.

The type of chemotherapy depends on the type of cancer being treated and the PRETEXT or POSTTEXT group.

Radiotherapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill or stop the growth of cancer cells. There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation to cancer cells.

Internal radiation therapy uses radioactive material sealed in a needle, seed, wire, or catheter that is placed directly in or near cancer cells.

Radioembolization of the hepatic artery (the aorta that supplies blood to the liver) is one type of internal radiation therapy used to treat liver cancer in children. Microbeads moistened with a small amount of radioactive material are injected into the hepatic artery through a catheter (thin tube). The microbeads are mixed with a hepatic artery blocking substance to cut off the blood supply to the tumor. Most of the radioactive material is immobilized around the tumor to kill the cancer cells. This therapy is used to reduce the symptoms and improve the quality of life of children with hepatocellular carcinoma.

The type of radiation therapy depends on the type of cancer being treated and the PRETEXT or POSTTEXT group. External radiation therapy is used to treat hepatoblastoma that cannot be removed surgically or has spread to other parts of the body.

Ablation therapy

Ablation therapy removes or destroys tissue. Different types of ablative therapy are available for hepatocellular carcinoma:

Radiofrequency ablation: A special needle is used to insert directly into the skin or through an abdominal incision into the tumor. High-energy radio waves heat the needle and tumor, killing the cancer cells. Radiofrequency ablation is used to treat recurrent hepatoblastoma.

Transdermal ethanol injection: Ethanol (pure alcohol) is injected directly into the tumor with a small needle to kill the cancer cells. Treatment may require multiple injections. Transdermal ethanol injections are used to treat recurrent hepatoblastoma.

Antiviral therapy

Hepatocellular carcinoma associated with hepatitis B virus can be treated with antiviral drugs.

Clinical trials are testing new therapies.

This overview section describes the treatments being studied in clinical trials. It may not mention each new therapy being studied. Information about clinical trials is available from the NCI website.

Targeted therapy

Targeted therapy is a treatment that uses a drug or other substance to attack specific cancer cells. Tyrosine kinase inhibitor (TKI) therapy is one type of targeted therapy. TKIs block the signals needed for tumor growth. Sorafenib and pazopanib are TKIs being studied for the treatment of recurrent hepatocellular carcinoma and newly diagnosed undifferentiated embryonal sarcoma of the liver.

Patients may want to be considered for participation in clinical trials.

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

Many standard treatments for cancer today are based on previous clinical trials. Patients who participate in a clinical trial may receive standard treatment or be able to get priority to try a new therapy.

Patients who participate in clinical trials are also helping to improve future treatments for cancer. Even if a clinical trial fails to find an effective new treatment, it usually answers important questions and moves research forward.

Patients can participate in a clinical trial before, during, or after they start cancer treatment.

Some clinical trials only take patients who have not yet started treatment. Other trials offer therapy testing for patients whose cancer has not yet gotten better. There are also clinical trials that offer tests of new therapies to prevent cancer from coming back (regenerating) or to reduce the side effects of cancer treatment.

Clinical trials are being conducted in many parts of the country. Information about NCI-supported clinical trials can be found on the NCI’s Clinical Trials Search page. Clinical trials supported by other organizations can be found on the Clinical trials.gov website.

Follow-up tests that may be needed

Some repeat tests are done to diagnose cancer or identify a treatment group; others are done to see how well the treatment is working. Decisions to continue, change, or stop treatment may all be based on the results of these tests.

There are tests that will continue from time to time after treatment ends. The results of these tests may show whether the child’s condition has changed or whether the cancer has come back (reoccurred). These tests are sometimes called follow-up tests or physicals.