Pediatric Liver Tumors

What are liver tumors?

• Liver tumors are benign or malignant abnormal cell growths that arise from the liver
• The different tumor types may require substantially different treatment.

What are the symptoms of liver tumors?

The symptoms of a pediatric liver tumor vary according to the size, type and location of the tumor. The most common symptoms include:

• A large mass in the abdomen
• Nausea or vomiting
• Jaundice (yellowing of the skin or eyes)
• Swollen abdomen
• Itchy skin
• Abdominal or back pain

How common are liver tumors?

• Overall, these tumors are rare in children, only affecting 1 in every 1,000,000 children. However, certain conditions may predispose children to liver tumors. For instance, children born very premature or with certain inherited conditions such as hemihypertrophy or Beckwith-Wiedemann syndrome may increase the risk for hepatoblastoma, while hepatocellular carcinoma is more common in children with viral hepatitis or with certain types of liver disease. Liver tumors can occur in any age, though certain subtypes, such as hepatoblastoma, tend to occur more frequently in younger children.

How are liver tumors diagnosed?

Depending on the type and site of the tumor, a variety of techniques may be used to diagnose liver tumors. These include:

• Biopsy, in which a pediatric surgeon performs a procedure to take a sample of the tumor in order to determine what type of tissue it is and to run special molecular tests.
• Blood tests. Certain types of tumors secrete chemicals, such as alpha-fetoprotein (AFP) that can be used to diagnose liver tumors and monitor their treatment. Blood tests can also help to evaluate liver function.
• Computed tomography (CT) scan, which uses a combination of X-rays and computer to produce images of the body, is useful for evaluating both bones and soft tissues.
• Positron emission tomography (PET) scan, which uses radioactive sugar injected into a vein, is sometimes used to determine if the tumor has spread to other areas of the body
• Bone scan, which uses a special radioactive dye to determine if the tumor has spread to any bones

How are liver tumors staged?

Staging of liver tumors depends on the specific type of tumor. For the most common liver tumor, hepatoblastoma, several staging systems are used:

• The pre-treatment extent of disease (PRETEXT) staging system is based on imaging of the liver before surgery is attempted. There are four main lobes of the liver. The PRETEXT stage corresponds to the number of lobes that have tumor in them. For example, if one lobe is involved, the disease is considered stage I. If all four lobes are involved, the disease is considered stage IV. Detailed information on the PRETEXT staging system can be found here.
• The Children’s Oncology Group (COG) staging system is based on additional imaging of other parts of the body, as well as the results of surgery, if surgery was performed at diagnosis. COG staging reflects how much of the tumor was removed and how much the tumor has spread.
  • Stage I: There is no tumor detectable outside of the liver. The tumor has been surgically removed at diagnosis and there are no cancer cells on the edges, or margins, of the removed tissue.
  • Stage II: There is no tumor detectable outside of the liver. The tumor has been surgically removed at diagnosis, but the margins of the removed tissue contain cancer cells.
  • Stage III: The tumor cannot be surgically removed at diagnosis because it is too big, it has grown into or presses on vital tissues in the liver, or it has spread to the lymph nodes that drain from the liver. In stage III disease, the tumor is not detectable in other parts of the body besides the liver and the lymph nodes close to the liver.
  • Stage IV: The tumor has obvious spread to other parts of the body, most commonly to the lungs.

How are liver tumors treated?

• Treatment for liver tumors may involve a combination of therapies including surgery, radiation and/or chemotherapy. Treatment options may vary greatly, depending on your child's situation. In addition, some children may require a liver transplant as part of their treatment. Our pediatric oncologists work closely with a multidisciplinary team to create a personalized treatment plan that is best for your child.

Surgery

• Surgery is often the first step in treating children with liver. In some cases, only a biopsy is done. This is often necessary when the tumor is too close to critical structures in the liver, or when the surgeon does not feel the tumor can be safely removed. In other cases, the tumor can be removed completely.

Chemotherapy

• To decrease the size of the tumor, kill tumor that has spread and prevent further tumor spread, your child may receive chemotherapy.

Radiation therapy

• High-energy X-rays or other types of radiation can kill cancer cells or stop them from growing. Radiation therapy is used in certain types of tumors to either shrink the tumor prior to surgery, or to try to prevent the tumor from coming back after surgery.

Liver transplant

• In cases where the tumor cannot be safely resected, liver transplant is often the best option for cure. Our team of liver transplant specialists has been recognized as the #1 in the nation.

What clinical trials does Ochsner Children’s Hospital offer for liver tumors?

• As part of the Children’s Oncology Group, Ochsner Hospital for Children is an active participant in children’s cancer research. We currently have multiple clinical trials available to treat children and young adults with various types of liver tumors.
• Active clinical trials for melanoma at Ochsner Children’s