Understanding Pediatric Liver Cancer

Cancer is an excessive growth of tissue due to uncontrolled cell division. Cell division is a normal process in our body where new cells are formed for tissue growth or to replace old/dead cells. The cancer can affect any organ in the body. Cancer does not occur only in old age but also seen in childhood. Unlike adults, children are not able to express their pains and problems. Because the children have developing cells, cancer treatment will also damage cells other than the cancerous ones.Liver-Cancer

Liver is the largest organ in the body that has many important metabolic and synthetic functions and occupies right upper quadrant of abdomen. The cause of the most primary liver tumors is unknown, as is the case for most forms of cancer. A few risk factors like preterm/low-birth weight, Hepatitis-B and family history will increase the chance of childhood liver cancer. Delayed diagnosis and treatment will lead to decreased survival rate. If the child experiences relapse, the treatment period extends over a period of time with least survival rate. Childhood cancer treatment requires specialized diagnostic and therapeutic capabilities and infrastructure. Follow up is crucial. Greater awareness of childhood cancer among the general public may help to increase the survival rate.

Liver cancer can be primary (cancer which starts in the liver) or secondary (which spreads from other organs). Primary liver cancer is mainly of two types. Hepatoblastoma usually occurs in children under 5 years of age. Hepatocellular carcinoma usually occurs in older children and adolescents and more in Asia due to viral hepatitis. More children than ever are surviving childhood cancer. There are newer, better drugs and treatment. It is devastating to hear that a child has cancer, and at times it can seem overwhelming but there are many healthcare professionals and supportive organizations to help families and their loved ones through these difficult times.

The cause of the most primary liver cancer is unknown, but children who are infected with hepatitis- B have a higher chance of developing Hepatocellular cancer in late childhood than uninfected children.  Most of the children would present with abdominal mass, so while giving bath or massage especially mother/ maid will notice the mass. Children would have abdominal pain, yellowish discoloration of the body, loss of appetite and loss of weight.  At this time parents should consult the doctor.

A variety of tests and investigations like Alfa-feto protein (AFP) levels, ultrasonography, CT and MRI scan needs to be carried out to diagnose the cancer. AFP is also known as tumor marker which is a useful indicator of whether the liver tumor is responding to treatment or whether it may have come back after treatment. The diagnosis is confirmed by taking a sample of cells from the tumor (biopsy) done under anesthesia. To assess the extent of the cancer, a grouping system called Pretext is used. The grouping process is essential because liver tumors need to be removed surgically. Grouping divides the liver into four surgical areas and gives an indication of the kind of surgery that is needed to remove the tumor.

In Hepatoblastoma the type of treatment will depend on the staging and whether the cancer has spread to other parts of the body (metastatic disease). Chemotherapy (Anti-cancer drugs) is given first. The aim of chemotherapy is to shrink the tumor in the liver. Surgery to remove the tumor (cancer mass) will take place after a few weeks of chemotherapy.

In Hepatocellular carcinoma the role of chemotherapy is less certain and surgery is the main treatment. Doctors usually recommend removing the tumor at the time of diagnosis (if it is small enough). If the tumor is too large, chemotherapy is given to shrink tumor.

These tumors don’t always respond to chemotherapy, so other treatments such as chemo-embolization, targeted treatments like anti-angiogenesis drugs may be used. If the tumor involves all sections of liver, a liver transplant will probably be necessary.

With regard to side effects for your child, the doctor will discuss these with you before treatment starts. Side effects include hair loss, an increased risk of infection, bleeding, tiredness, diarrhea, nausea and vomiting. Late side effects of chemotherapy may include hearing problems, kidney problems, heart problems and developing another type of cancer later in life. Recurrence is cancer that comes back after initial treatment; it can come back in the liver or in other parts of body. AFP levels are used as an indicator. Specialist doctors, pediatric surgeons, pediatric oncologists will carry out treatment plan and follow up care. Many other useful organizations also exist.

In pediatric liver cancer, especially Hepatoblastoma, there has been a very positive outcome with the current treatment modalities. Fifty years ago these tumors had a mortality rate of about 90%. However, with current treatment the success of such pediatric cancer cures are about 90 to 95%.

Inputs by Dr. Rajeev Redkar, Consultant Pediatric Surgeon at Fortis SL Raheja Hospital



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