eMedicine Specialties > Pediatrics: General Medicine > Oncology

Hepatocellular Carcinoma: Follow-up

Author: Girindra G Raval, MD, Staff Physician, Department of Internal Medicine, University of Arkansas School of Medicine
Coauthor(s): Paulette Mehta, MD, MPH, Professor of Hematology/Oncology, Department of Internal Medicine, Co-Director of Fellowship Program, Medical Director of Hematology/Oncology at CAVHS, University Arkansas for Medical Sciences and Central Arkansas Veterans Hospital System
Contributor Information and Disclosures

Updated: Feb 23, 2009

Follow-up

Further Inpatient Care

  • Follow-up of patients with hepatocellular carcinomas (HCCs) varies. For the child who requires only surgery, only good postoperative management of the surgical site and assessment of liver function tests may be required. If the a -fetoprotein or B12 binding protein levels are abnormal, these markers of tumor burden, in addition to previously abnormal imaging studies, necessitate close follow-up monitoring. Patients with abnormal scans also require follow-up monitoring, usually at 2-month to 3-month intervals or sooner if clinically indicated.
  • Grade III to grade IV mucositis, grade III to grade IV myelosuppression, febrile neutropenia, anorexia, and cachexia most likely occur in the patient who receives chemotherapy. These problems require hospitalization and management by a team of individuals who are versed in the toxicities of high-dose chemotherapy.

Prognosis

  • Survival
    • The 5-year survival rates for patients undergoing multiagent therapy and surgical resection are as follows:
      • Group I - Approximately 85-90%
      • Group II - 55-60%
      • Groups III and IV - Less than 20%
    • Surgery is the mainstay of treatment in hepatocellular carcinoma; thus, factors like multifocal tumor, vascular invasion, and presence of metastatic disease, which preclude surgical resection, are important prognostic factors for survival.1 Liver transplantation may play a role in the treatment of children with advanced disease; however, survival rates have not exceeded 30% at 2 years follow-up, and distant metastatic disease precludes this therapeutic strategy. Although chemotherapeutic and radiotherapeutic modalities are associated with numerous toxicities, even a temporary reduction in tumor size can greatly enhance a child's quality of life by alleviating tumor-associated pain and hepatic dysfunction.
    • Earlier claims for a better outcome of fibrolamellar versus hepatocellular carcinoma have not been substantiated.1
  • Future directions
    • Identification in a young patient requires a careful evaluation for a preexisting underlying liver disorder. With careful staging and adjuvant therapy, many patients can be treated with intent-to-cure, especially if localized disease is identified in the initial staging workup.
    • This disease awaits a well-organized clinical trial to best determine which chemotherapeutic agents, duration of therapy, and use of radiation might best benefit affected children. The formation of the Children's Oncology Group within the United States suggests that a clinical trial specifically designed to answer these questions may be forthcoming.

Miscellaneous

Medicolegal Pitfalls

  • Management of hepatocellular carcinoma (HCC) requires a multidisciplinary team of specialists versed in the complexities of pediatric cancer.
  • Although formal management is undertaken by the pediatric oncology team, the primary care physician is encouraged to help when possible but is not expected to act as primary case manager.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Stuart Winter, MD, to the development and writing of this article.



More on Hepatocellular Carcinoma

Overview: Hepatocellular Carcinoma
Differential Diagnoses & Workup: Hepatocellular Carcinoma
Treatment & Medication: Hepatocellular Carcinoma
Follow-up: Hepatocellular Carcinoma
References
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References

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Further Reading

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Keywords

hepatocellular carcinoma, hepatoma, HCC, fibrolamellar carcinoma, malignant hepatoma, hepatocarcinoma, liver cell carcinoma, liver disease, liver dysfunction, parenchymal cells, liver, tumor, cancer, cirrhosis, hepatitis B, hepatitis C, hemochromatosis, Gaucher disease, Gaucher's disease, biliary atresia, infantile cholestasis, glycogen-storage disease, cirrhosis, hepatitis B, hepatitis C, liver dysfunction, tyrosinemia, pleural effusions

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Contributor Information and Disclosures

Author

Girindra G Raval, MD, Staff Physician, Department of Internal Medicine, University of Arkansas School of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Paulette Mehta, MD, MPH, Professor of Hematology/Oncology, Department of Internal Medicine, Co-Director of Fellowship Program, Medical Director of Hematology/Oncology at CAVHS, University Arkansas for Medical Sciences and Central Arkansas Veterans Hospital System
Paulette Mehta, MD, MPH is a member of the following medical societies: American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, and American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

Stephan A Grupp, MD, PhD, Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania
Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Steven K Bergstrom, MD, Assistant to the Chairman, Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland
Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology
Disclosure: Nothing to disclose.

CME Editor

Helen SL Chan, MBBS, FRCP(C), FAAP, Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA, Senior Vice President, Children's National Medical Center (Center for Cancer and Blood Disorders); Director, Center for Cancer and Immunology Research, Children's Research Institute, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University
Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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