Hepatocellular Carcinoma (Hepatoma)

Hepatocellular carcinoma (HCC), or hepatoma, is a very rare childhood liver cancer in which cancer cells develop in the tissues of the liver and form a tumor.

The liver is one of the largest organs in the body. It is in the upper right-hand side of the abdomen under the ribs. The liver has many functions. For instance, it plays an important role in turning food into energy; it also filters and stores blood.

HCC is one of two types of primary liver cancer. Hepatoblastoma is the other type of primary liver cancer; metastatic liver tumors are those that start elsewhere and spread to the liver.

HCC is found in children from birth to 19 years of age. Children with metabolic liver disease that causes liver scarring (such as tyrosinemia and alpha-1 antitrypsin deficiency) and those infected with hepatitis B or C (viral infections of the liver that cause inflammation) are more likely than other children to get HCC.

The cause of HCC is unknown. Genes that are not normal that are passed down (inherited) are thought to play a role; however, it is not clear what causes the tumor to develop. 

The early symptoms of HCC are often not unique to liver disorders. At the time of diagnosis, patients often:

  • Are tired
  • Have a fever
  • Have pain in the belly
  • Have a loss of appetite
  • Appear thin and sick

As the cancer tumor grows, the patient may also have symptoms such as:

  • Pain in the upper right part of the belly that stretches into the back and shoulder
  • A collection of fluid in the abdominal cavity (space inside the walls of the belly that contains most of the organs of digestion)
  • Bleeding in the digestive tract (tube of the digestive system through which food passes and digestion takes place)
  • Jaundice (a condition that causes the skin to turn yellow and the urine to become dark-colored)

If your child's doctor suspects liver cancer, your child's history will be checked for risk factors. In addition, close attention is paid to the condition of your child's belly during physical exams.

Masses or lumps in the liver and belly often can be felt while your child is lying flat on the exam table. The liver usually is swollen and hard in patients with liver cancer.

The doctor also may be able to hear an unusual sound or rubbing noise when using a stethoscope to listen to the blood vessels that lie near the liver. The pressure of the tumor on the blood vessels causes the noises.

Your child's doctor may use other methods to diagnose HCC. They include:

Blood tests. Between 50 percent to 70 percent of liver patients have high levels of something called serum alpha-fetoprotein. Blood tests can tell if high levels are present in your child's blood. This test cannot be used by itself to diagnose HCC, as other diseases can also cause high levels. More blood work, including hepatitis B, iron, total iron binding capacity, ferritin and alpha-1 antitrypsin may help uncover any predisposing factors.

Imaging studies. Imaging studies help find tissue in the liver that is not normal. Liver tissue as small as an inch across now can be detected by ultrasound or computed tomography scan (CT scan). However, these imaging studies cannot tell the difference between a hepatocellular carcinoma and other abnormal masses or lumps of tissue.

Biopsy. A biopsy (removal and examination of a sample of tissue) of the tumor may be done to provide a definite diagnosis of HCC. This involves either removal of a sample of the liver or tissue fluid or complete tumor resection (removal), which is then checked under a microscope to see if there are cancer cells present.

Once HCC is found, more tests are done to find out if cancer cells have spread to other parts of the body. This is called staging. Your child's doctor needs to know the stage of the disease to provide the right treatment.

The following stages are used to define HCC:

  • Stage I means the cancer can be removed with surgery.
  • Stage II means most of the cancer may be removed in an operation, but very small amounts of cancer are left in the liver following surgery.
  • Stage III means that some of the cancer may be removed in an operation, but some of the tumor cannot be removed and remains either in the belly or in the lymph nodes (part of the body that filters out and gets rid of cancer cells and other waste products from the body).
  • Stage IV means the cancer has spread to other parts of the body.

There are two main kinds of treatment used for children with HCC. Treatment requires several doctors to work together: a hepatologist (liver doctor), a surgeon (doctor who operates) and an oncologist (cancer doctor).

Surgery. Surgery may be used to take out the cancerous tumor and part of the liver where the cancer is found. If surgery to remove the tumor is not possible, a child may have a liver transplant. Liver transplantation is a treatment option in some patients with Stage II or III cancer. The transplant removes the diseased liver and replaces it with a healthy one from a donor. This is not an option if the cancer has spread beyond the liver.

Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be given to your child before surgery to help shrink the size of the liver cancer. Your child may be given chemotherapy after surgery to kill any remaining cancer cells.

Chemotherapy for HCC usually is put into the body through a needle in a vein or artery. The drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. Your child's doctor also may deliver the chemotherapy directly into the blood vessels that go into the liver.

Your doctor may decide to put chemotherapy drugs into the liver's main artery with substances that block or slow the flow of blood into the cancer. This lengthens the time the drugs have to kill the cancer cells. It also prevents the cancer cells from getting oxygen or other materials that they need to grow.

The stage of your child's disease and your child's age and general health will determine the treatment used. Usually, treatment for HCC is determined according to its stage:

  • Stage I: Your child's treatment probably will be complete removal of the liver cancer by surgery, followed by chemotherapy
  • Stage II: Your child's treatment probably will be removal of the liver cancer by surgery, followed by chemotherapy
  • Stages III and IV: Your child's treatment probably will be chemotherapy to reduce the size of the tumor. Then there will be surgery to remove as much of the cancer as possible. 

A child's chances of recovery depend on the stage of the cancer (whether it has spread to other parts of the body), the treatment used and the child's overall health.

For additional information on this topic, please contact the Cancer and Blood Diseases Institute at Cincinnati Children's, cancer@cchmc.org.

Last Updated 10/2012