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Childhood Liver Cancer Treatment (PDQ®)

  • Last Modified: 09/30/2013

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Stages of Childhood Liver Cancer



After childhood liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.

The process used to find out if cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

  • Surgery : An operation will be done to look at or remove the tumor. Tissues removed during surgery will be checked by a pathologist.

There are two staging systems for childhood liver cancer.

Two staging systems are used for childhood liver cancer:

  • Presurgical staging: The stage is based on where the tumor has spread within the four parts (sections) of the liver, as shown by imaging procedures such as MRI or CT. This staging system is called PRETEXT and it is done before the patient has surgery.
  • Postsurgical staging: The stage is based on the amount of tumor that remains after the patient has had surgery to look at or remove the tumor.

The following stages are used to describe liver cancer that is staged before surgery:

The liver is divided into 4 vertical sections.

PRETEXT Stage 1

Enlarge
Liver PRETEXT Stage 1; drawing shows two livers. Dotted lines divide each liver into four vertical sections of about the same size.  In the first liver, cancer is shown in the section on the far left.  In the second liver, cancer is shown in the section on the far right.
PRETEXT Stage 1. Cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them.

In stage 1, the cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them.

PRETEXT Stage 2

Enlarge
Liver PRETEXT Stage 2; drawing shows five livers. Dotted lines divide each liver into four vertical sections that are about the same size. In the first liver, cancer is shown in the two sections on the left.  In the second liver, cancer is shown in the two sections on the right. In the third liver, cancer is shown in the far left and far right sections. In the fourth liver, cancer is shown in the second section from the left.  In the fifth liver, cancer is shown in the second section from the right.
PRETEXT Stage 2. Cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them.

In stage 2, cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them.

PRETEXT Stage 3

Enlarge
Liver PRETEXT Stage 3; drawing shows seven livers. Dotted lines divide each liver into four vertical sections that are about the same size. In the first liver, cancer is shown in three sections on the left.  In the second liver, cancer is shown in the two sections on the left and the section on the far right. In the third liver, cancer is shown in the section on the far left and the two sections on the right.  In the fourth liver, cancer is shown in three sections on the right.  In the fifth liver, cancer is shown in the two middle sections.  In the sixth liver, cancer is shown in the section on the far left and the second section from the right.  In the seventh liver, cancer is shown in the section on the far right and the second section from the left.
PRETEXT Stage 3. Cancer is found in three sections of the liver and one section does not have cancer. OR, cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.

In stage 3, one of the following is true:

  • Cancer is found in three sections of the liver and one section does not have cancer.
  • Cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.

PRETEXT Stage 4

Enlarge
Liver PRETEXT Stage 4; drawing shows two livers. Dotted lines divide each liver into four vertical sections that are about the same size. In the first liver, cancer is shown across all four sections. In the second liver, cancer is shown in the two sections on the left and spots of cancer are shown in the two sections on the right.
PRETEXT Stage 4. Cancer is found in all four sections of the liver.

In stage 4, cancer is found in all four sections of the liver.

The following stages are used to describe liver cancer that is staged after surgery:

Stage I and Stage II

In stage I, the tumor was in the liver only and all of the cancer was removed by surgery.

In stage II, the tumor was in the liver only. After the cancer was removed by surgery, a small amount of cancer remains that can only be seen with a microscope.

Stage III

In stage III:

Stage IV

In stage IV, the cancer has spread to other parts of the body, such as the lung or brain.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if childhood liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.