Types of Liver Cancer Treatments
There are a number of treatments for childhood liver tumors. Hepatoblastoma in children and hepatocellular carcinoma in children are treated differently. Although both tumors require complete surgical removal for treatment to be successful, they respond differently to chemotherapy. Hepatoblastoma responds well to chemotherapy while HCC tumors are usually treated with surgery alone.
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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, HCC is very resistant to chemotherapy. Different combinations of cisplatin, vincristine, 5-fluorouracil and doxorubicin are used.
Chemoembolization
Sometimes, when systemic (delivered 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 and oxygen 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:
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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.
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.
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.
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.
