Childhood hepatocellular carcinoma

Other Names: Childhood Carcinoma of Liver Cell; Childhood Hepatoma; Childhood Liver Cell Carcinoma; Pediatric Carcinoma of Liver Cell; Pediatric Hepatocellular Carcinoma; Pediatric Hepatoma; Pediatric Liver Cell Carcinoma

Childhood hepatocellular carcinoma (childhood HCC) is a rare type of malignant (cancerous) tumor that forms in the cells and tissues of the liver. Childhood HCC is usually found in older children and adolescents (10-14 years), but has been found in children younger than 5.

Epidemiology

The frequency of childhood hepatocellular carcinoma (childhood HCC) varies significantly worldwide. It is estimated to occur in about one out of two million people per year.Males tend to be diagnosed more often than females.Childhood HCC is found more commonly in sub-Saharan Africa and Southeast Asia. Researcher suggest this is due to a higher incidence of hepatitis B and aflatoxin exposure.

Cause

The cause of childhood hepatocellular carcinoma (childhood HCC) is not well understood. Unlike adult HCC, childhood HCC may be found in individuals with no underlying liver disease. Children living in regions of the world where the hepatitis B virus is common have been reported to have a much greater risk of developing this disease. Chronic infection by hepatitis C virus has also been linked to the development of childhood HCC.Childhood HCC has also been reported to develop in the presence of liver disease, cirrhosis, and genetic disorders such as tyrosinemia type 1, glycogen storage disease type 1, and glycogen storage disease type IV. In addition, various other reported risk factors for developing childhood HCC include: male sex, family history of this carcinoma, and exposure to aflatoxin by food contamination.

Signs and symptoms

The symptoms of childhood hepatocellular carcinoma (childhood HCC) are similar to the symptoms found in other liver cancers, commonly presenting with an abdominal mass and pain. Other common symptoms include abdominal swelling and discomfort, weight loss, anorexia, fever, vomiting, and yellowing of the skin and eyes (jaundice).

For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. 80%-99% of people have these symptoms

• Abdominal pain(Pain in stomach)
• Elevated alpha-fetoprotein
• Hepatic fibrosis
• Hepatomegaly(Enlarged liver)

30%-79% of people have these symptoms

• Epigastric pain
• Fatigue(Tired)
• Hepatic necrosis
• Portal vein thrombosis(Blood clot in portal vein)
• Vomiting(Throwing up)

Diagnosis

Although there are no standard or routine screening tests for liver cancer, the following tests are being used or studied to screen for it:

Ultrasound Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off the liver and make echoes. The echoes form a picture of the liver called a sonogram. The picture can be printed to be looked at later.

CT scan CT scan is a procedure that makes a series of detailed pictures of the liver, 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 liver show up more clearly. This procedure is also called CAT scan or computed tomography.

Tumor markers

Tumor markers, also called biomarkers, are substances made by the tumor that may be found in the blood, other body fluids, or tissues. A high level of a specific tumor marker may mean that a certain type of cancer is present in the body.

Alpha-fetoprotein (AFP) is the most widely used tumor marker for detecting liver cancer. However, other cancers and certain conditions, including pregnancy, hepatitis, and other types of cancer, may also increase AFP levels.

Specific tumor markers that may lead to early detection of liver cancer are being studied.

Treatment

The treatment for childhood hepatocellular carcinoma (childhood HCC) is dependent on a number of factors including the PRETEXT and POSTTEXT group. This is a way of describing the tumor before treatment (PRETEXT) and after treatment (POSTTEXT). The course of treatment is additionally dependent on whether or not a tumor can be initially removed with surgery and whether the cancer has spread (metastasized) to other parts of the body. Treatment options for a tumor that can be removed by surgery at the time of diagnosis may include:

• Surgery alone to remove the tumor
• Surgery and chemotherapy
• Combination chemotherapy followed by surgery to remove the tumor
• Treatment options for a tumor that cannot be removed by surgery at the time of diagnosis may include:
• Chemotherapy to shrink the tumor followed by surgery
• Chemotherapy to shrink the tumor and if surgery to remove the tumor is not possible: liver transplant or chemoembolization of the hepatic artery to shrink the tumor
• Radioembolization of the hepatic artery to relieve symptoms and improve quality of life
• Treatment for a childhood HCC that has spread to other parts of the body may include a combination of chemotherapy and surgery to remove as much of the tumor from the liver as possible as well as other places where the cancer has spread. If the childhood HCC is related to a hepatitis B viral infection, treatment may additionally include antiviral medications.

NIH genetic and rare disease info

• NIH info on Childhood hepatocellular carcinoma

Childhood hepatocellular carcinoma is a rare disease.

Childhood hepatocellular carcinoma Resources
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