Liver Tumors (Pediatric)
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What are liver tumors?
The liver is the third-most-common site for abdominal tumors in children. Tumors of the liver may be either malignant (cancerous) or benign (non-cancerous).
Children with liver tumors may have a bulging abdomen that makes their belly look larger, a lump in the abdomen, or both, and may also experience weight loss, fever, and a loss of appetite. In newborns and infants, liver tumors are often accompanied by other more serious symptoms, including congestive heart failure and respiratory distress.
The most common benign liver tumors are called hemangiomas. Hemangiomas commonly occur within the first 6 months of life. Infants with this condition may have a swollen belly, which can be seen to be caused by a liver tumor during imaging tests. Many hemangiomas go away on their own in the first 2 years of life, however, others require therapy.
The most common malignant liver tumors are called hepatoblastomas (HB), which make up 43% of all pediatric liver tumors. HB tumors are often discovered after a child comes in with a lump or mass in the abdominal area. This condition is often passed down in families.
Hepatocellular carcinoma (HCC) is another common cause of malignant liver tumors. It occurs most often in children aged 0-4 years or between age 10-14 years. It is more common in patients who have had previous liver conditions such as hepatic fibrosis or viral hepatitis.
Our approach to liver tumors
Treatment options for hemangiomas include high-doses of corticosteroids, propranolol (a beta blocker), interferon-alpha (a medication that works in the immune system), and chemotherapy, in which medicines attack the tumors directly. Lesions or sores on the liver are removed by surgery or procedures that block the blood flow to the lesion.
In rare cases when the disease is spread throughout the liver or hasn’t responded to other therapy, the health care provider may recommend a liver transplant.
If HB is suspected, laboratory studies are performed to measure the levels of enzymes and other substances in the liver. An important test is for a protein called α -fetoprotein (AFP). AFP levels are high in up to 90% of children with HB. Regularly measuring AFP levels is one way your health care provider can tell who effective treatment is. and it is a valuable surveillance marker to determine the effectiveness of treatment.
Other tests usually also include taking images with an ultrasound, CT scanning, MRI of the abdomen and chest, and an procedure called angiography that uses xrays to see where the lesions are and how many there are. However, definitive diagnosis can be confirmed only by a biopsy, in which a small amount of tissue is removed and examined under a microscope.
In HB, the main goal of therapy is surgical removal of the cancerous part of the liver (called resection.) Up to half of the liver can be removed and the rest of the organ still function, as long as it is healthy. However, about half of liver tumors can’t be removed surgically, either because of their size or location. Some tumors can be shrunk through chemotherapy, then removed. In some cases, liver transplant may be recommended.
Hepatocellular carcinoma (HCC)
At first, HCC looks the similar to HB, as far as symptoms. The tests conducted for diagnosis are also similar. In HCC, more than 70% of these tumors are considered unable to be removed by surgery, and unlike HB, chemotherapy is not as effective in shrinking these tumors. Complete surgical resection or transplantation is often the best chance for survival.
Newer therapeutic strategies have included chemoembolization, which blocks blood flow to the tumors, intra-arterial chemotherapy, which distributes the chemotherapy medications closer to the tumors through the arteries, and immunotherapy, which uses medications that affect the immune system to target the tumors.