In Treatment

There are a number of treatments for liver tumors.  Hepatoblastoma and hepatocellular carcinoma are treated in different ways.  Although both tumors require complete surgical removal for treatment to be successful, they respond differently to chemotherapy.  Hepatoblastoma responds well to chemotherapy while hepatocellular carcinoma tumors are usually treated with surgery alone.

Surgery

Surgical removal of the tumor is the most important component of successful treatment for liver tumors.  An operation is performed to remove the tumor and the part of the liver where the cancer cells are found.  If the cancer cells have spread to other parts of the body, surgery may also remove the tumors from these areas.  The most common places for liver cancer to spread include tissues that surround the liver, the lungs or the brain.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells.  Chemotherapy may be used before surgery to shrink the tumor so that it can be surgically removed, or it can be used after surgery to destroy any remaining cancer cells.  While hepatoblastoma usually responds very well to chemotherapy, hepatocellular carcinoma is very resistant to chemotherapy.  Different combinations of cisplatin, vincristine, 5-fluorouracyl and doxorubicin are used.

Chemoembolization

Sometimes, when systemic (through the blood stream) chemotherapy doesn’t work, chemoembolization is used as a treatment.  This means that the chemotherapy medications are placed directly into the tumor.  In the case of liver cancer, the main artery that delivers blood to the liver is injected with chemotherapy drugs and embolizing substances (treatments that block or slow the flow of blood to the tumor).  This prevents nutrients from feeding the tumor and gives the chemotherapy drugs more time to destroy the cancer cells.

Liver transplantation

If the tumor has spread throughout the liver, or it is not possible to preserve enough normal liver when surgically removing the tumor, the liver may be replaced entirely with a portion of healthy liver.  Patients who have a liver transplant need to take medications to suppress the immune system for the rest of their lives.

Factors Affecting Survival

Factors that affect treatment type and cure rate include:
  1. Complete tumor resection (removal): Children whose tumors can be completely removed by surgery are most likely to be cured.  When tumors cannot be completely removed at the time of diagnosis, chemotherapy is often given prior to surgery to shrink the tumor and improve the chances of complete removal.
  2. Presence of "pure fetal histology:" After a biopsy or surgical removal of the tumor, a pathologist examines the tumor tissue and determines whether the tumor cells resemble those present in a fetal liver (pure fetal histology).  These children have an excellent cure rate if their tumors are completely removed.
  3. Tumor stage: Earlier stage tumors (I or II) are more easily cured.  However, 70% of liver tumors are late stage (III or IV) when they are diagnosed.
  4. Alphafetoprotein (AFP) production: Most liver tumors produce a substance called AFP.  Children who have an abnormally high AFP at diagnosis that rapidly decreases when initially treated with chemotherapy may have a more favorable cure rate.  Children who have a normal or only slightly elevated AFP do not do as well and may require different treatment.

Research Studies

The majority of children with cancer participate in research studies.  This high rate of participation has been essential to improving the cure rates for children’s cancer.

Researchers design various studies to improve treatment and advance the understanding of cancer and its causes.  Clinical trials are carefully reviewed and must be approved through a formal scientific process before anyone can be enrolled.  If there is a research study “open” that your child is “eligible for,” you may be asked to allow your child to participate.  It is also possible that your child will be asked to participate in more than one study.

Whether an individual is eligible for a particular study may depend on age, location of the cancer, the extent of the disease and other information.  Researchers usually must limit their study to some of these characteristics to have a scientifically valid study.  Further, researchers must follow exactly the same restrictions throughout the study.

If your child is eligible to participate in one or more study, your doctor will discuss these with you during an initial treatment conference (also called informed consent conference).  The doctor will describe the study, potential risks of participation, and other information you need to decide whether or not you would like your child to participate in the study.  You always have the choice to participate or not in research studies.

If you do choose to have your child participate in a study, you doctor will explain what type of information you will receive about the results of the study.  The overall results of the research study will be published to inform the public and other researchers.  No study will publish any information that identifies an individual.

Visit the Clinical Trials section of this website to learn more about the various kinds of research studies.

Last updated September, 2011

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