Liver Cancer

Your liver is the largest internal organ in your child’s body and helps to filter harmful substances like poisons and toxins out of your child’s blood. It also creates bile, which your child’s body uses to digest the fats they eat and stores the sugar that their body uses for energy.

Normally, cells in your child’s body reproduce at a certain rate and live for a certain time before dying. Sometimes, these cells can be damaged in a way that causes them to grow too fast or stops them from dying. This can lead to a lump of cells called a tumor. When this tumor starts spreading through your child’s liver or other parts of their body, it is called liver cancer.

There are 2 kinds of liver cancer:

1. Primary. Primary liver cancer is cancer that starts in your child’s liver.
2. Metastatic [meh-tuh-STAT-ik]. Metastatic liver cancer is cancer that has spread to your child’s liver from another part of the body, like the stomach, lungs, or lymph nodes.

Liver cancer is a serious disease, and your child’s chances of recovering or surviving depend on a few factors, such as other diseases they might have and, most importantly, the stage of the cancer. A stage is a way of describing how much the cancer has grown, and whether it has spread to other parts of the body. Liver cancer stages are a bit different than stages for some other cancers since doctors often use the Barcelona Clinic Liver Cancer (BCLC) Staging System. The stages of liver cancer in this system include:

• Stage 0. Small, early tumors grow at this stage without causing symptoms. Treatment for this stage could include partial liver removal.
• Stage A. Tumors are larger than in Stage 0 but still don’t cause any symptoms. Treatments for this stage include liver transplant, liver removal, or tumor removal.
• Stage B. The liver has multiple tumors during this stage, but these still might not be causing any symptoms. Embolization [em-buh-luh-ZEY-shuhn] is the recommended treatment for this stage. Embolization is the blocking of the blood supply to the tumor.
• Stage C. Tumors have started to cause symptoms during this stage and might be spreading through the liver or to other parts of the body. Treatments can include clinical trials, medicine, or palliative care.
• Stage D. At this stage, cancer has spread throughout the body. Treatment at this stage focuses on the symptoms, rather than trying to cure the disease.

The symptoms of liver cancer can vary depending on the individual person, the stage of the disease, and other factors. Common symptoms include:

• A hard lump on the right side of your child’s body below their rib cage.
• Pain, pressure, or swelling on the right side of your child’s upper abdomen (belly).
• Pain near your child’s right shoulder blade or in their back.
• Jaundice [JAWN-dis], which is when your child’s skin and eyes turn yellow.
• Tiredness or weakness, especially for no reason.
• Not having any appetite or losing weight for no reason.
• Pale stool (poop) and dark urine.
• Nausea or vomiting.
• Fever.

Sometimes, a child might not have any symptoms at all, especially during the early stages of the disease. If the liver cancer has metastasized (spread to other parts of your child’s body), they might have symptoms from other types of cancer.

You should talk to your doctor right away if your child has any of the symptoms of liver cancer listed above. Finding liver cancer early can give your child’s medical team more time to try different treatments and increases your child’s chances of survival and recovery. Some of the symptoms of liver cancer can be caused by other conditions that your child’s doctor can rule out with tests.

The basic cause of liver cancer is damage to the cells in the liver. Usually, this damage just kills the cell, but sometimes it can make the cell start to grow and replicate without stopping. This can result in a lump of cells called a tumor. If this tumor starts to spread to other parts of the body, it is called cancer.

Most of the time, doctors aren’t sure what causes the cell damage that leads to liver cancer, but they have found some things that can increase your child’s chances of developing this disease. Some of these risk factors include:

• Hepatitis [HEP-uh-TYE-tis] B or hepatitis C infections.
• Heavy alcohol use.
• Cirrhosis [SIHR-oh-SIS] of the liver.
• Hemochromatosis [HEE-moh-KROH-muh-TOE-sis], a disease that makes it hard for your body to store iron.
• Obesity.
• Diabetes.

If your doctor thinks your child has liver cancer, the doctor will do a physical exam to look for basic symptoms of the disease. During the exam, they will ask you and your child questions about your child’s medical history and might put pressure on your abdomen, ribcage, and back to look for pain, tenderness, or lumps.

After the exam, your doctor might order one or several of these tests:

• Serum tumor marker test. Your child’s blood contains many different substances.  When your child has cancer, there might be too much or too little of these substances in their blood, and the serum tumor marker test looks for abnormal levels of these substances.
• Liver function tests. Liver cancer can stop your liver from working well, which can change the level of certain substances in the blood. A liver function test measures the level of these substances in a sample of your child’s blood to check how well their liver is functioning.
• Imaging tests. CT scans, MRIs, and ultrasounds let your doctor take pictures of your liver, which can show tumors, abnormal growths, and damage to the organ that could be a sign of cancer.
• Biopsy. During a biopsy, a small piece of your liver is removed and is sent to a laboratory for testing. This is the most reliable test for liver cancer and will be done if your doctor thinks it’s likely that you have this disease.

If your child has liver cancer, their doctors and other members of their medical team will work together to decide on the treatment that will work best for you. Their recommendation will depend on several factors, such as:

• Stage. Treatment might be different if your child’s liver cancer is at an early stage and has not spread to other parts of your body.
• Spread. If your child’s liver cancer metastasizes, it will spread to other parts of your body. Depending on where the cancer is, some treatments could be more or less effective.
• Other conditions. If your child has other medical conditions, some treatments might not work as well or might have more risks.

There are many possible treatments for liver cancer, such as:

• Surveillance. This is the most basic treatment. If your child’s doctor only finds very small (less than 1 centimeter, or one-third of an inch across) tumors in the liver, they might do surveillance rather than any of the treatments below. This means that they will schedule regular follow-ups, usually every 3 months, to keep track of your child’s cancer and see how it changes.
• Surgery. The most common surgery for liver cancer is partial hepatectomy [HEP-uh-TEK-tuh-MEE], a procedure where the cancerous part of the liver is removed. The rest of the liver can still filter poisons from your child’s body, and sometimes the liver can regrow.
• Liver transplant. If the cancer has spread through your whole liver, your child might need a liver transplant. In this procedure, your child’s liver is replaced with the liver from another person, called an organ donor.
• Ablation [ahb-LAY-shun] therapy. This procedure destroys or kills the cancerous tissue in the liver. Unlike in surgery, the liver is not actually removed. There are several different kinds of ablation therapy, including:
  • Radiofrequency ablation. A needle is inserted into the tumor and heated up using powerful radio waves. This heat kills the tissue in the tumor.
  • Microwave therapy. The tumor is exposed to microwaves, which damages or kills the cancer cells.
  • Percutaneous [PUHR-cue-TAY-nee-US] ethanol injection. Ethanol, or pure alcohol, is injected into the tumor which stops it from growing.
  • Cryoablation [KRY-OH-ab-LAY-shun]. In this treatment, the cancerous liver tissue is killed by freezing.
• Electroporation [EE-lek-TRO-poor-AY-shun] therapy. Electrical pulses are sent through the tumor, which also kills the cells.
• Embolization [EM-buh-liz-AY-shun] therapy. This treatment blocks the blood flow through the liver, which stops the tumor from getting the oxygen and nutrients it needs to grow. This treatment is most often used for patients who can’t have surgery and is most effective if the cancer hasn’t spread to other parts of your child’s body.
• Targeted therapy. This treatment uses medicines that attack cancer cells but leave normal cells alone. Some medicines kill the cancer cells, while others only stop the cells from dividing, which stops the tumor from getting any bigger.
• Radiation therapy. Radiation therapy uses high-energy x-rays or other radio waves that are focused on the tumors in the liver. These waves can kill the cancer cells or damage them so they can’t grow anymore.

Doctors don’t always know what causes liver cancer, so in many ways, there is no sure way to prevent it. However, there are some steps your child can take to reduce their risk factors for liver cancer and other types of cancer, such as:

• Drinking in moderation. Drinking too much alcohol can cause cirrhosis of the liver and put your child at risk for liver and other cancers.
• Eating a healthy diet. An unhealthy diet can lead to diabetes and obesity, which can both increase your child’s risk of getting liver cancer.
• Getting vaccines. There is no vaccine for hepatitis C, but your child can get a vaccine for hepatitis B, especially if they are at risk of getting this disease or have other risk factors for liver cancer.

Doctors and scientists are always working to develop new treatments for liver cancer. One step in this process is a clinical trial, where cancer patients are recruited to take the new medicine or have the new procedure. While a clinical trial might not be effective for your cancer, it is something you and your doctor can talk about, especially if other treatments haven’t worked.

Liver cancer is abnormal cell growth in the liver, the organ that filters your blood and helps your body digest food. Cancer cells grow too fast and don’t die, which can cause tumors, or growths, in the liver. Sometimes, the cancer metastasizes, which means it can spread and do damage to other parts of your body.