Liver cancer

Liver tumours are quite rare in children. Primary liver tumours are those that start in the liver, rather than those which began in another part of the body and have spread to the liver. The following information is about primary liver tumours, or liver cancer.

Liver cancer is divided into two types

Hepatoblastoma which occurs in younger children under five
Hepatocellular carcinoma which is very rare and occurs in older children and adults

The liver itself is the largest organ in the body. It does a number of things, including breaking down waste in the body, converting certain foods into energy and destroying harmful substances.

The symptoms are a lump or pain in the tummy (abdomen), weight loss, sickness and loss of appetite.

A blood test will be given because the blood of children who have liver cancer may have increased amounts of a protein called alpha-fetoprotein (AFP). This is known as a tumour marker.

Other tests will include an ultrasound scan and a MRI scan to find out if there is a tumour and also if it has spread to other parts of the body.

The treatment will depend upon the type of liver cancer, and also its PRETEXT (which is its ‘pre-treatment extent of the disease’).

The main treatment for liver cancer is surgery, so the PRETEXT divides the liver into four sectors and describes how many sectors are affected. This way, the Consultant can tell what type of surgery is needed.

• PRETEXT 1 – only one sector affected – straightforward surgery
• PRETEXT 2 – two sectors affected (that are next to each other) which will mean more extensive surgery
• PRETEXT 3 – three sectors affected but they can be removed surgically
• PRETEXT 4 – all sectors affected which cannot be removed surgically apart from by using a liver transplant.

Once the PRETEXT of the cancer has been established the cancer will be treated first with chemotherapy to try and shrink the tumour as much as possible before surgery.

Children will then have surgery on any remaining tumour in the liver.

If the cancer has spread, the secondary tumour will be removed first with chemotherapy or surgery. The liver will be operated upon after recovery from this.

Rarely, if the tumour is in all four sectors of the liver, a transplant will be recommended for children with hepatoblastoma. Parents can discuss this with their child’s Consultant as each case will have its own specific circumstances.
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The side-effects associated with chemotherapy are tiredness, sickness and diarrhoea, temporary hair loss and infection, all of which can be managed with help from the child’s Consultant or nursing team.  For more information about side-effects please visit our side-effects section.

Long term side-effects
Some children may go on to develop longer term side effects. Please remember that all children are different and only a small number develop long-term problems as a result of their treatment. Parents can talk to their child’s Consultant if they are concerned about them and can visit our beyond treatment section for general information.

Follow-up care
All children will need to be monitored regularly at an outpatient's clinic. The Consultant will be looking for any signs that the cancer has returned (recurrent cancer) and checking the functions of major organs to make sure that they have not been affected by the cancer treatment. 

Levels of AFP in the blood will be tested as a rise may indicate a recurrence of the cancer.