Pediatric Liver (Hepatic) Tumors
Hepatic (liver) cancer is rare in children. The most common mass in younger children is hepatoblastoma. Older children and adolescents are more likely to be diagnosed with hepatocellular carcinoma, which more readily metastasizes.
Because liver cancers are so rare in pediatric patients and often associated with genetic syndromes, the tumors should be managed by a multidisciplinary team of pediatric specialists.
Tests and Diagnosis
Diagnosing liver cancer includes distinguishing masses from hemangiomas, which are the most common benign liver mass. Hemangiomas are most often found in infants less than 6 months old. Mesenchymal hamartomas are rare benign masses usually found in children under 2 years old.
Although malignant, hepatoblastoma usually does not spread beyond the liver. About 90% of hepatic malignancies in children age 4 or younger are hepatoblastomas. The tumor is associated with a number of genetic conditions, including:
Hepatocellular carcinoma has a lower 5-year survival rate than that for hepatoblastoma. The carcinoma is associated with some familial syndromes and in some regions with a high incidence of Hepatitis B, which children acquire perinatally.
Other types of liver malignancies are even rarer:
- Undifferentiated embryonal sarcoma of the liver, which usually occurs in children between age 5 and 10 years.
- Infantile choriocarcinoma of the liver, which originates in the placenta and appears in a young infant’s liver.
- Epithelioid hemangioendothelioma, a rare vascular cancer.
Children with a liver malignancy usually have a painless mass or swelling in the abdomen. Some children have pain, nausea, vomiting and unexplained weight loss. Serum tumor markers can identify elevated beta-human chorionic gonadotropic or alpha-fetoprotein levels. Liver function tests and blood chemistry studies can indicate liver disease. Imaging in children usually begins with ultrasonography and may be followed by computed tomography and magnetic resonance imaging as necessary. A biopsy confirms diagnosis and immunohistochemistry may be used to determine genetic causes of liver tumors.
Surgery options range from cryosurgery to total hepatectomy and liver transplant. Children’s performed more than 50 solid organ transplants last year. Our surgeons are board certified in pediatric surgery, along with either general surgery or a surgical subspecialty. Our pediatric surgeons and urologists participate in important clinical trials and our oncology department is consistently ranked as a top pediatric program in the country by U.S. News &World Report.
Children also may need chemotherapy and radiation therapy, depending on the stage and type of liver tumor. Percutaneous ethanol injection can be used to target and destroy liver cancer cells. Because liver tumors are rare, children should be considered for enrollment in a clinical trial when possible.
We will continue to work with patients’ families and community physicians after care to assist you with follow-up and surveillance for recurrence or a second cancer.
Children’s Medical Center is staffed by expert and experienced specialists who are faculty at UT Southwestern Medical Center. The Pauline Allen Gill Center for Cancer and Blood Disorders, or Gill Center, is a world-class and nationally recognized leader in pediatric cancer research. Our pediatric oncologists, pediatric surgeons and other specialists can manage these rare tumors.