The treatment options for different types of pediatric liver cancer vary, and parents need to discuss with their doctors what treatment options are right for their child.
Children with hepatoblastoma
Children with hepatocellular carcinoma
undifferentiated embryonal sarcoma of the liver in children
Infantile choriocarcinoma of the liver
Recurrent hepatocellular carcinoma in children
I. Hepatoblastoma of the liver in children
Hepatoblastoma that can be surgically removed , treatment options include:
- Hepatoblastoma with pure fetal histology, surgical removal of the tumor followed by watchful waiting or chemotherapy;
- Hepatoblastoma with histology that is not purely fetal. Combination chemotherapy is given preoperatively and/or postoperatively. For small cell undifferentiated hepatoblastoma, give aggressive chemotherapy.
For hepatoblastoma that is not surgically resectable or unresectable, treatment options include:
- combination chemotherapy to shrink the tumor, followed by surgical removal of the tumor;
- combination chemotherapy followed by liver transplantation;
- hepatic artery chemoembolization (TACE) to shrink the tumor followed by surgical removal of the tumor.
Hepatoblastoma that has spread to other parts of the body should be given combination chemotherapy to shrink the tumor in the liver and metastases to other parts of the body. After chemotherapy, imaging is performed to determine if the tumor can be surgically removed. Their treatment options include:
- Surgical removal of the tumor if it can be removed in the liver and elsewhere in the body, followed by chemotherapy to kill any remaining cancer cells;
- Liver transplantation if the tumor in the liver cannot be removed surgically, but there is no sign of cancer elsewhere in the body;
- If the tumor cannot be removed elsewhere in the body or if a liver transplant is not possible, chemotherapy, hepatic artery chemoembolization, or radiation therapy may be performed.
II. Hepatocellular carcinoma in children
For pediatric hepatocellular carcinoma that can be surgically resected, treatment options include:
- Surgical resection of the tumor alone;
- Surgical removal of the tumor followed by chemotherapy;
- combined chemotherapy followed by surgical removal of the tumor.
For children with hepatocellular carcinoma that cannot be surgically removed, treatment options include:
- chemotherapy to shrink the tumor followed by complete surgical removal of the tumor;
- chemotherapy to shrink the tumor. If surgery does not completely remove the tumor, further treatment may include.
- liver transplantation;
- hepatic artery chemoembolization to shrink the tumor, followed by surgery to remove the tumor if possible or liver transplantation;
- hepatic artery chemoembolization alone;
- hepatic artery radioembolization as palliative treatment to relieve symptoms and improve quality of life.
For children with hepatocellular carcinoma that has clearly spread to other parts of the body at the time of diagnosis, treatment options include:
- chemoembolization to shrink the tumor, followed by surgery to remove as much of the intrahepatic tumor and metastases from other parts of the body as possible. Studies have found that this approach is not very effective, but some patients can benefit from it.
For children with hepatocellular carcinoma associated with hepatitis B virus (HBV) infection, treatment options include:
- Surgical removal of the tumor;
- Treatment of hepatitis B virus infection with antiviral drugs.
III. Undifferentiated embryonal sarcoma of the liver in children
Treatment options for undifferentiated embryonal sarcoma of the liver include:
- combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible, with chemotherapy also given after tumor resection;
- Surgical removal of the tumor, followed by chemotherapy, which can be followed by a second surgery to remove the residual tumor, followed by chemotherapy again;
- If the tumor cannot be surgically removed, a liver transplant can be performed.
IV. Choriocarcinoma of the liver in infants
Treatment options for choriocarcinoma of the liver in infants include:
- Combination chemotherapy to shrink the tumor followed by surgical removal of the tumor;
- Surgical removal of the tumor.
V. Recurrent hepatoblastoma in children
Treatment options for recurrent hepatoblastoma in children include:
- surgical resection of an isolated (single, independent) metastatic tumor and/or chemotherapy;
- combination chemotherapy;
- liver transplantation;
- Participation in clinical trials of new treatments.
Treatment options for children with progressive or recurrent hepatocellular carcinoma include:
- hepatic artery chemoembolization prior to liver transplantation to shrink the tumor;
- Liver transplantation;
- Participation in clinical trials of new treatments.
Treatment options for recurrent undifferentiated embryonal sarcoma of the liver in children include:
- Clinical trials that detect specific genetic changes in patients’ tumor samples to determine which targeted therapy to use based on the patient’s type of mutation.
Treatment options for infants with recurrent hepatic choriocarcinoma include:
- Clinical trials that detect specific genetic changes in a patient’s tumor sample to determine which targeted therapy to use based on the patient’s type of mutation.