Treatment Option Overview
There are different types of treatment for patients with childhood liver cancer.
Different types of treatments are available for children with liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with liver cancer and who specialize in certain areas of medicine. It is especially important to have a pediatric surgeon with experience in liver surgery. Other specialists may include the following:
- Radiation oncologist.
- Pediatric nurse specialist.
- Rehabilitation specialist.
- Psychologist.
- Social worker.
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or after treatment and continue 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.
- Second cancers (new types of cancer).
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer 1 for more information).
Five types of standard treatment are used:
When possible, the cancer is removed by surgery.
- Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. The doctor may use ultrasound to guide the instrument.
- Partial hepatectomy: Removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with a small amount of normal tissue around it.
- Total hepatectomy and liver transplant: Removal of the entire liver and replacement with a healthy liver from a donor. A liver transplant may be possible when cancer has not spread beyond the liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
- Resection of metastases: Surgery to remove cancer that has spread outside of the liver, such as to nearby tissues, the lungs, or the brain.
Some of the factors that affect the type of surgery used include the following:
- The PRETEXT stage (stage of the cancer before surgery).
- The size of the primary tumor.
- Whether there is more than one tumor in the liver.
- Whether the cancer has spread to blood vessels.
- The level of alpha-fetoprotein in the blood.
- Whether the tumor can be shrunk by chemotherapy so that it can be removed by surgery.
- Whether a liver transplant is needed.
Chemotherapy is sometimes given before surgery, to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Chemoembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of regional chemotherapy used to treat childhood liver cancer. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented 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 intestine.
Treatment using more than one anticancer drug is called combination chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Percutaneous ethanol injection
Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web site 2.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Termsabdomen (AB-doh-men)The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.abnormal (ab-NOR-mul) Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).adjuvant therapy (A-joo-vunt THAYR-uh-pee) Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.alcohol (AL-kuh-hol) A chemical substance found in beer, wine, and liquor, and some medicines, mouthwashes, household products, and essential oils (scented liquid taken from plants). Alcohol contains a carbon atom attached to a hydroxyl group (a molecule made of an oxygen atom and a hydrogen atom).alpha-fetoprotein (AL-fuh-FEE-toh-PROH-teen) A protein normally produced by a fetus. AFP levels are usually undetectable in the blood of healthy adult men or women (who are not pregnant). An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. Also called AFP.artery (AR-tuh-ree) A blood vessel that carries blood from the heart to tissues and organs in the body.blood (blud) A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.blood vessel (blud VEH-sel) A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.cancer (KAN-ser) A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.carcinoma in situ (KAR-sih-NOH-muh in SY-too) A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.catheter (KA-theh-ter) A flexible tube used to deliver fluids into or withdraw fluids from the body.cavity (KA-vih-tee) A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.cell (sel) The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.cerebrospinal fluid (seh-REE-broh-SPY-nul FLOO-id) The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.chemoembolization (KEE-moh-EM-boh-lih-ZAY-shun) A procedure in which the blood supply to the tumor is blocked surgically or mechanically and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of timechemotherapy (KEE-moh-THAYR-uh-pee) Treatment with drugs that kill cancer cells.clinical trial (KLIH-nih-kul TRY-ul) A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.combination chemotherapy (KOM-bih-NAY-shun KEE-moh-THAYR-uh-pee) Treatment using more than one anticancer drug.condition (kun-DIH-shun) In medicine, a health problem with certain characteristics or symptoms.cryosurgery (KRY-oh-SER-juh-ree) A procedure in which tissue is frozen to destroy abnormal cells. Liquid nitrogen or liquid carbon dioxide is used to freeze the tissue. Also called cryoablation and cryosurgical ablation.diagnosis (DY-ug-NOH-sis) The process of identifying a disease, such as cancer, from its signs and symptoms.donor (DOH-ner) In medicine, a person who gives blood, cells, tissue, or an organ for use in another person, such as in a blood transfusion or an organ transplant.drug (drug) Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee) A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.follow-up (FAH-loh-up) Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.healthcare provider (HELTH-kayr proh-VY-der) A licensed person or organization that provides healthcare services.hepatectomy (HEH-puh-TEK-toh-mee) Surgery to remove all or part of the liver.hepatic artery (heh-PA-tik AR-tuh-ree) The major blood vessel that carries blood to the liver.hepatic portal vein (heh-PA-tik POR-tul vayn) A blood vessel that carries blood to the liver from the stomach, small and large intestines, spleen, pancreas, and gallbladder. Also called portal vein.injection (in-JEK-shun) Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee) A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.intestine (in-TES-tin) The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.late effects (layt eh-FEKTS) Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.liver (LIH-ver) A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.liver cancer (LIH-ver KAN-ser) Primary liver cancer is cancer that forms in the tissues of the liver. Secondary liver cancer is cancer that spreads to the liver from another part of the body.lobe (lobe) A portion of an organ, such as the liver, lung, breast, thyroid, or brain.lung (lung) One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.medicine (MEH-dih-sin) Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.metastasis (meh-TAS-tuh-sis) The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).monitor (MAH-nih-ter) In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).NCI NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.neoadjuvant therapy (NEE-oh-A-joo-vant THAYR-uh-pee) Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy.nutrient (NOO-tree-ent) A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.organ (OR-gun) A part of the body that performs a specific function. For example, the heart is an organ.oxygen (OK-sih-jen) A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.PDQ PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.pediatric nurse specialist (pee-dee-A-trik ... SPEH-shuh-list) A registered nurse with an advanced degree in nursing who specializes in the care of children.pediatric oncologist (pee-dee-A-trik on-KAH-loh-jist) A doctor who specializes in treating children with cancer.pediatric surgeon (pee-dee-A-trik SER-jun) A surgeon who specializes in the treatment of children. A surgeon removes or repairs a part of the body by operating on the patient.percutaneous ethanol injection (per-kyoo-TAY-nee-us EH-thuh-nol in-JEK-shun) An injection of ethanol (alcohol) through the skin directly into a tumor to kill cancer cells. Ultrasound or a CT scan is used to guide the needle into the tumor. Also called alcohol ablation, ethanol ablation, and PEI.primary tumor (PRY-mayr-ee TOO-mer) The original tumor.psychologist (sy-KAH-loh-jist) A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.radiation (RAY-dee-AY-shun) Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).radiation oncologist (RAY-dee-AY-shun on-KAH-loh-jist) A doctor who specializes in using radiation to treat cancer.radiation therapy (RAY-dee-AY-shun THAYR-uh-pee) The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.radioactive (RAY-dee-oh-AK-tiv) Giving off radiation.radioactive seed (RAY-dee-oh-AK-tiv...) A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.recur (ree-KER) To come back or to return.regional chemotherapy (REE-juh-nul KEE-moh-THAYR-uh-pee) Treatment with anticancer drugs directed to a specific area of the body.rehabilitation specialist (REE-huh-BIH-lih-TAY-shun SPEH-shuh-list) A healthcare professional who helps people recover from an illness or injury and return to daily life. Examples of rehabilitation specialists are physical therapists and occupational therapists.research study (reh-SERCH STUH-dee) A scientific study of nature that sometimes includes processes involved in health and disease. For example, clinical trials are research studies that involve people. These studies may be related to new ways to screen, prevent, diagnose, and treat disease. They may also study certain outcomes and certain groups of people by looking at data collected in the past or future.resection (ree-SEK-shun) Surgery to remove tissue or part or all of an organ.second primary cancer (SEH-kund PRY-mayr-ee KAN-ser) Refers to a new primary cancer in a person with a history of cancer.side effect (side eh-FEKT) A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.social worker (SOH-shul WUR-ker) A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.specialist (SPEH-shuh-list) In medicine, a doctor or other health care professional who is trained and licensed in a special area of practice. Examples of medical specialists include oncologists (cancer specialists) and hematologists (blood specialists).stage (stayj) The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.standard therapy (... THAYR-uh-pee) Treatment that experts agree is appropriate, accepted, and widely used. Also called best practice, standard medical care, and standard of care.stomach (STUH-muk) An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.surgery (SER-juh-ree) A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.symptom (SIMP-tum) An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.systemic chemotherapy (sis-TEH-mik KEE-moh-THAYR-uh-pee) Treatment with anticancer drugs that travel through the blood to cells all over the body.tissue (TIH-shoo) A group or layer of cells that work together to perform a specific function.transplantation (tranz-plan-TAY-shun) A surgical procedure in which tissue or an organ is transferred from one area of a person’s body to another area, or from one person (the donor) to another person (the recipient).tumor (TOO-mer) An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.ultrasound (UL-truh-SOWND) A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.vein (vayn) A blood vessel that carries blood to the heart from tissues and organs in the body.watchful waiting (WACH-ful WAY-ting) Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management.wedge resection (wej ree-SEK-shun) Surgery to remove a triangle-shaped slice of tissue. It may be used to remove a tumor and a small amount of normal tissue around it.x-ray (EX-ray) A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer. |
Table of Links | |
| 1 | http://www.cancer.gov/cancertopics/pdq/treatment/lateeffects/Patient |
| 2 | http://cancer.gov/clinicaltrials |
