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Liver Tumour / Cancer in Children
Liver tumours account for approximately 1% of all childhood cancers. The nature of liver cancers in children is entirely different from those seen in adults. In children, the most common type is hepatoblastoma, whereas in adults, it is hepatocellular carcinoma.
The encouraging aspect of liver tumours in children is their high curability rate—up to 95%—with appropriate chemotherapy and surgical resection, even in advanced stages. In contrast, outcomes for adult liver cancers remain poor, even when diagnosed early.
Clinical Presentation
Parents often first notice abdominal distension in their child and seek medical attention. In the early stages, the tumour may not be detected through routine physical examination, and an ultrasound of the liver is required for diagnosis. Occasionally, children may present with constipation as a symptom. Unlike adult liver diseases, these children rarely develop jaundice or signs of chronic liver disease such as vomiting blood.
After a few months, when the abdomen becomes significantly distended, the tumour may become palpable on clinical examination. Hepatoblastomas produce a marker called alpha-fetoprotein (AFP), which can be measured in the blood to confirm the diagnosis. AFP levels are also used to monitor disease activity, and a return to normal values usually indicates complete remission.
Treatment
Chemotherapy is the cornerstone of treatment and typically involves six cycles in total. Each cycle lasts 21 days. The chemotherapy drugs are administered over three days of inpatient care, followed by an 18-day rest period during which the child can return home.
Surgical liver resection is generally performed after the completion of four cycles of chemotherapy. However, if the tumour is large or located near vital structures such as major blood vessels or bile ducts, resection may not be feasible. In such cases, liver transplantation becomes the preferred treatment option.
Following surgery or transplantation, two additional cycles of chemotherapy are administered to eliminate any remaining cancer cells and reduce the risk of recurrence.