Childhood Liver Cancer Symptoms, Tests, Prognosis, and Stages (PDQ®)–Patient Version

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General Information About Childhood Liver Cancer

Key Points

  • Childhood liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.
  • There are different types of childhood liver cancer.
  • Certain diseases and disorders can increase the risk of childhood liver cancer.
  • Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen.
  • Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Childhood liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.

The liver is one of the largest organs in the body. It has four lobes and fills the upper right side of the abdomen inside the rib cage. Three of the many important functions of the liver are:

  • To filter harmful substances from the blood so they can be passed from the body in stools and urine.
  • To make bile to help digest fats from food.
  • To store glycogen (sugar), which the body uses for energy.
Enlarge Anatomy of the liver; drawing shows the right and left lobes of the liver. Also shown are the bile ducts, gallbladder, stomach, spleen, pancreas, small intestine, and colon.
Anatomy of the liver. The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas. The liver has a right lobe and a left lobe. Each lobe is divided into two sections (not shown).

Liver cancer is rare in children and adolescents.

There are different types of childhood liver cancer.

There are two main types of childhood liver cancer:

  • Hepatoblastoma: Hepatoblastoma is the most common type of childhood liver cancer. It usually affects children younger than 3 years of age.

    In hepatoblastoma, the histology (how the cancer cells look under a microscope) affects the way the cancer is treated. The histology for hepatoblastoma may be one of the following:

    • Pure fetal histology.
    • Small cell undifferentiated histology.
    • Non-pure fetal histology, non-small cell undifferentiated histology.
  • Hepatocellular carcinoma: Hepatocellular carcinoma usually affects older children and adolescents. It is more common in areas of Asia that have high rates of hepatitis infection than in the U.S.

Three less common types of childhood liver cancer include the following:

This summary is about the treatment of primary liver cancer (cancer that begins in the liver). Treatment of metastatic liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary. Primary liver cancer can occur in both adults and children. However, treatment for children is different than treatment for adults. See the PDQ summary on Adult Primary Liver Cancer Treatment for more information on the treatment of adults.

Certain diseases and disorders can increase the risk of childhood liver cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk.

Risk factors for hepatoblastoma include the following syndromes or conditions:

Risk factors for hepatocellular carcinoma include the following syndromes or conditions:

Some patients with tyrosinemia or progressive familial intrahepatic disease will have a liver transplant before there are signs or symptoms of cancer.

Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen.

Signs and symptoms are more common after the tumor gets big. Other conditions can cause the same signs and symptoms. Check with your child’s doctor if your child has any of the following:

Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.

The following tests and procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Serum tumor marker test : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The blood of children who have liver cancer may have increased amounts of a hormone called beta-human chorionic gonadotropin (β-hCG) or a protein called alpha-fetoprotein (AFP). Other cancers and certain noncancer conditions, including cirrhosis and hepatitis, can also increase AFP levels.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • Liver function tests : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver damage or cancer.
  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin or lactate dehydrogenase (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Epstein-Barr virus (EBV) test: A blood test to check for antibodies to the EBV and DNA markers of the EBV. These are found in the blood of patients who have been infected with EBV.
  • Hepatitis assay : A procedure in which a blood sample is checked for pieces of the hepatitis virus.
  • MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the liver. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
    EnlargeMagnetic resonance imaging (MRI) of the abdomen; drawing shows a child lying on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.
    Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. In childhood liver cancer, an ultrasound exam of the abdomen to check the large blood vessels is usually done.
    EnlargeAbdominal ultrasound; drawing shows a child lying on an exam table during an abdominal ultrasound procedure. A technician is shown pressing a transducer (a device that makes sound waves that bounce off tissues inside the body) against the skin of the abdomen. A computer screen shows a sonogram (picture).
    Abdominal ultrasound. An ultrasound transducer connected to a computer is pressed against the skin of the abdomen. The transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, 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. In childhood liver cancer, a CT scan of the chest and abdomen is usually done.
    EnlargeComputed tomography (CT) scan of the abdomen; drawing shows a child lying on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.
    Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.
  • Abdominal x-ray : An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
  • Biopsy : The removal of a sample of cells or tissues so it can be viewed under a microscope to check for signs of cancer. The sample may be taken during surgery to remove or view the tumor. A pathologist looks at the sample under a microscope to find out the type of liver cancer.

    The following test may be done on the sample of tissue that is removed:

    • Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test is used to check for a certain gene mutation and to tell the difference between different types of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options for hepatoblastoma depend on the following:

  • The PRETEXT or POSTTEXT group.
  • Whether the cancer has spread to other places in the body, such as the lungs or certain large blood vessels.
  • Whether the cancer can be removed completely by surgery.
  • How the cancer responds to chemotherapy.
  • How the cancer cells look under a microscope.
  • Whether the AFP blood levels go down after treatment.
  • Whether the cancer has just been diagnosed or has recurred.
  • Age of the child.

The prognosis (chance of recovery) and treatment options for hepatocellular carcinoma depend on the following:

  • The PRETEXT or POSTTEXT group.
  • Whether the cancer has spread to other places in the body, such as the lungs.
  • Whether the cancer can be removed completely by surgery.
  • How the cancer responds to chemotherapy.
  • How the cancer cells look under a microscope.
  • Whether the child has hepatitis B infection.
  • Whether the cancer has just been diagnosed or has recurred.

For childhood liver cancer that recurs (comes back) after initial treatment, the prognosis and treatment options depend on:

  • Where in the body the tumor recurred.
  • The type of treatment used to treat the initial cancer.

Childhood liver cancer may be cured if the tumor is small and can be completely removed by surgery. Complete removal is possible more often for hepatoblastoma than for hepatocellular carcinoma.

Stages of Childhood Liver Cancer

Key Points

  • 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.
  • There are two grouping systems for childhood liver cancer.
  • There are four PRETEXT and POSTTEXT groups:
    • PRETEXT and POSTTEXT Group I
    • PRETEXT and POSTTEXT Group II
    • PRETEXT and POSTTEXT Group III
    • PRETEXT and POSTTEXT Group IV
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.

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, to nearby tissues or organs, or to other parts of the body is called staging. In childhood liver cancer, the PRETEXT and POSTTEXT groups are used instead of stage to plan treatment. The results of the tests and procedures done to detect, diagnose, and find out whether the cancer has spread are used to determine the PRETEXT and POSTTEXT groups.

There are two grouping systems for childhood liver cancer.

Two grouping systems are used for childhood liver cancer:

  • The PRETEXT group describes the tumor before the patient has treatment.
  • The POSTTEXT group describes the tumor after the patient has treatment.

There are four PRETEXT and POSTTEXT groups:

The liver is divided into 4 sections. The PRETEXT and POSTTEXT groups depend on which sections of the liver have cancer.

PRETEXT and POSTTEXT Group I

Enlarge Liver PRETEXT I; 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.
Liver PRETEXT I. 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 group I, 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 and POSTTEXT Group II

Enlarge Liver PRETEXT II; 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.
Liver PRETEXT II. 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 group II, 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 and POSTTEXT Group III

Enlarge Liver PRETEXT III; 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.
Liver PRETEXT III. 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 group III, 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 and POSTTEXT Group IV

Enlarge Liver PRETEXT IV; 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.
Liver PRETEXT IV. Cancer is found in all four sections of the liver.

In group IV, cancer is found in all four sections of the liver.

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.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

Recurrent Childhood Liver Cancer

Recurrent childhood liver cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the liver or in other parts of the body. Cancer that is growing or worsening during treatment is progressive disease.

  • Updated: December 7, 2017

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