Hepatocellular Carcinoma

What is hepatocellular carcinoma?

Hepatocellular carcinoma is a type of liver cancer that usually affects people whose livers have been under extra strain for a long time because of infections, metabolic diseases or prolonged use of certain drugs, including:

• Infections with viral hepatitis B or C
• Ethanol, the form of alcohol used in alcoholic beverages
• Androgenic anabolic steroids

Children are more likely to develop hepatocellular carcinoma in these cases:

• They are infected with hepatitis B or C—viral infections that can damage the liver through time. (There is a vaccine for protection against hepatitis B, but not for hepatitis C.)
• They drink a lot of alcohol or are long-time users of androgenic anabolic steroids
• They have the following congenital (present at birth) diseases and conditions:
  • Alpha-1 antitrypsin deficiency
  • Ataxia telangiectasia
  • Budd-Chiari syndrome
  • Galactosemia
  • Hemochromatosis
  • Hereditary tyrosinemia
  • Type 1 glycogen storage disease
  • Wilson’s disease

Only about a third of children diagnosed with hepatocellular carcinoma have one of these risk factors.

How common is hepatocellular carcinoma?

• Hepatocellular carcinoma is very rare in children, especially those younger than 5.
• Less than one child in a million is diagnosed with this disease.
• The disease is usually diagnosed in children between ages 12 and 14.

What are the symptoms of hepatocellular carcinoma?

Symptoms of hepatocellular carcinoma include the following:

• Swelling or pain in the abdomen (belly)
• A mass or lump in the upper right side of the abdomen
• Nausea and vomiting
• Loss of appetite
• Weight loss
• Fever

How is hepatocellular carcinoma treated?

Hepatocellular carcinoma is not curable without complete removal of all tumor with surgery. This could require a liver transplant if the tumor involves the whole liver. Other treatments may include the following:

• Chemoembolization — is used to kill the tumor by injecting microscopic (very small) beads into the blood vessels that supply the tumor. The beads block the vessels, so the tumor “starves.” Chemo may be used along with chemoembolization.
• Chemical injection — is used to kill smaller tumors by injecting a chemical such as ethanol directly into the tumor.
• Radiofrequency ablation — is used to kill the tumor by inserting a probe that sends radio waves directly into the tumor.
• Liver transplant — may be the best option for some children if the cancer has not spread outside the liver.
• Chemotherapy (“chemo”) — uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells. Unfortunately only one medicine, called sorafenib, has been proven to slow the progress of hepatocellular carcinoma. It is taken by mouth.
  • Other chemo may be tried along with sorafenib or if sorafenib does not work.
  • Combination therapy uses more than one type of chemo at a time.

What are the survival rates for hepatocellular carcinoma in children?

The overall survival rate is less than 30%. However, the patient may become disease-free if treated with the following:

• Complete removal of the tumor
• Liver transplant, if the cancer has not spread outside the liver

Why choose St. Jude for your child’s hepatocellular carcinoma treatment?

• St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
• St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
• The nurse-to-patient ratio at St. Jude is unmatched— averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
• St. Jude offers a dedicated team of specialists to meet the needs of children with hepatocellular carcinoma, including: surgeons; doctors and nurses who treat this cancer; doctors who specialize in pathology (making a diagnosis by looking at tumor tissue under the microscope) and in radiation therapy; experts in diagnostic imaging and nuclear medicine; genetic counselors; nutritionists; child life specialists; psychologists; researchers; scientists; and many others.
• Complete, quality surgery is an important part of treating hepatocellular carcinoma. The expert skills and experience of St. Jude specialty surgeons can help improve patients’ chances for best outcomes.
• St. Jude has access to new “experimental” medicines that can be used if the cancer comes back or becomes resistant to the initial treatment.