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Pediatric Hepatocellular Carcinoma Follow-up

  • Author: Paulette Mehta, MD, MPH; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
Updated: Nov 05, 2015

Further Inpatient Care

See the list below:

  • 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 α -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.



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, 6]

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.

However, one study noted favorable outcomes in children with cirrhosis, hepatocellular carcinoma, and no extrahepatic disease after primary orthotopic liver transplantation. In 8 of 10 patients studied, no tumor recurrence was noted after a median follow up of 4 years.[7]

Another study noted that surgical resection resulted in superior patient survival versus liver transplantation. Of 413 patients studied, 1- and 5-year survival rates were similar in both groups; however, survival rates were significantly improved in resected patients with hepatocellular carcinoma and model end-stage liver disease (MELD) scores of less than 10. Surgical resection should remain the first line of therapy for hepatocellular carcinoma patients who are candidates for resection.[8]

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.

Contributor Information and Disclosures

Paulette Mehta, MD, MPH Professor, Division of Hematology/Oncology and Palliative Care and Hospice Medicine, Department of Internal Medicine, 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, American Society of Hematology, Association of VA Hematology/Oncology, National Cancer Institute

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Steven K Bergstrom, MD 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, Children's Oncology Group, American Society of Clinical Oncology, International Society for Experimental Hematology, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA Executive Vice President, Chief Medical and Academic Officer, Renown Heath

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

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 School of Medicine

Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, Society for Pediatric Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.


Girindra G Raval, MD Staff Physician, Jefferson Regional Medical Center

Disclosure: Nothing to disclose.

Stuart S Winter, MD Associate Professor, Department of Pediatrics, University of New Mexico Health Sciences Center

Disclosure: Nothing to disclose.

  1. Czauderna P, Mackinlay G, Perilongo G, et al. Hepatocellular carcinoma in children: results of the first prospective study of the International Society of Pediatric Oncology group. J Clin Oncol. 2002 Jun 15. 20(12):2798-804. [Medline].

  2. Chou R, Cuevas C, Fu R, Devine B, Wasson N, Ginsburg A, et al. Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 May 19. 162 (10):697-711. [Medline].

  3. Evans AE, Land VJ, Newton WA, Randolph JG, Sather HN, Tefft M. Combination chemotherapy (vincristine, adriamycin, cyclophosphamide, and 5-fluorouracil) in the treatment of children with malignant hepatoma. Cancer. 1982 Sep 1. 50(5):821-6. [Medline].

  4. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008 Jul 24. 359(4):378-90. [Medline].

  5. Schmid I, Häberle B, Albert MH, Corbacioglu S, Fröhlich B, Graf N, et al. Sorafenib and cisplatin/doxorubicin (PLADO) in pediatric hepatocellular carcinoma. Pediatr Blood Cancer. 2012 Apr. 58(4):539-44. [Medline].

  6. Zhang XF, Liu XM, Wei T, Liu C, Li MX, Long ZD, et al. Clinical characteristics and outcome of hepatocellular carcinoma in children and adolescents. Pediatr Surg Int. 2013 Aug. 29(8):763-70. [Medline].

  7. Romano F, Stroppa P, Bravi M, et al. Favorable outcome of primary liver transplantation in children with cirrhosis and hepatocellular carcinoma. Pediatr Transplant. 2011 Sep. 15(6):573-9. [Medline].

  8. Koniaris LG, Levi DM, Pedroso FE, et al. Is surgical resection superior to transplantation in the treatment of hepatocellular carcinoma?. Ann Surg. 2011 Sep. 254(3):527-38. [Medline].

  9. Alagille D, Odievre M. Liver and Biliary Tract Disease in Children. New York, NY: John Wiley & Sons; 1979. 331.

  10. Berman MM, Libbey NP, Foster JH. Hepatocellular carcinoma. Polygonal cell type with fibrous stroma--an atypical variant with a favorable prognosis. Cancer. 1980 Sep 15. 46(6):1448-55. [Medline].

  11. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005 Nov. 42(5):1208-36. [Medline].

  12. Chlebowski RT, Tong M, Weissman J, et al. Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients. Cancer. 1984 Jun 15. 53(12):2701-6. [Medline].

  13. Degos F, Christidis C, Ganne-Carrie N, et al. Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death. Gut. 2000 Jul. 47(1):131-6. [Medline]. [Full Text].

  14. Evans AE, Land VJ, Newton WA, et al. Combination chemotherapy (vincristine, adriamycin, cyclophosphamide, and 5-fluorouracil) in the treatment of children with malignant hepatoma. Cancer. 1982 Sep 1. 50(5):821-6. [Medline].

  15. Farmer DG, Rosove MH, Shaked A, Busuttil RW. Current treatment modalities for hepatocellular carcinoma. Ann Intern Med. 1994. 219:236-47. [Medline].

  16. Giacomantonio M, Ein SH, Mancer K, Stephens CA. Thirty years of experience with pediatric primary malignant liver tumors. J Pediatr Surg. 1984 Oct. 19(5):523-6. [Medline].

  17. Greensberg M, Filler RM. Hepatic tumors. Pizzo PA, Poplack DG, eds. Principles and Practices of Pediatric Oncology. Philadelphia, PA: JB Lippincott Co; 1993.

  18. Jeffers LJ, Dubow RA, Zieve L, et al. Hepatic encephalopathy and orotic aciduria associated with hepatocellular carcinoma in a noncirrhotic liver. Hepatology. 1988 Jan-Feb. 8(1):78-81. [Medline].

  19. Kew MC, Fisher JW. Serum erythropoietin concentrations in patients with hepatocellular carcinoma. Cancer. 1986 Dec 1. 58(11):2485-8. [Medline].

  20. Levy LJ, Swinburne LM, Boulton RP, Losowsky MS. Primary hepatocellular carcinoma presenting as fulminant hepatic failure in a young woman. Postgrad Med J. 1986 Dec. 62(734):1135-7. [Medline].

  21. Mitchell RB, Wagner JE, Karp JE, et al. Syndrome of idiopathic hyperammonemia after high-dose chemotherapy: review of nine cases. Am J Med. 1988 Nov. 85(5):662-7. [Medline].

  22. Morita K, Okabe I, Uchino J, et al. The proposed Japanese TNM classification of primary liver carcinoma in infants and children. Jpn J Clin Oncol. 1983 Jun. 13(2):361-9. [Medline].

  23. Noda T, Sasaki Y, Yamada T, et al. Adult capillary hemangioma of the liver: report of a case. Surg Today. 2005. 35(9):796-9. [Medline].

  24. Paradinas FJ, Melia WM, Wilkinson ML, et al. High serum vitamin B12 binding capacity as a marker of the fibrolamellar variant of hepatocellular carcinoma. Br Med J (Clin Res Ed). 1982 Sep 25. 285(6345):840-2. [Medline].

  25. Ringe B, Wittekind C, Bechstein WO, et al. The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg. 1989 Jan. 209(1):88-98. [Medline].

  26. Schafer DF, Sorrell MF. Hepatocellular carcinoma. Lancet. 1999 Apr 10. 353(9160):1253-7. [Medline].

  27. Vaillo A, Rodriguez-Recio FJ, Gutierrez-Martin A, et al. Fine needle aspiration cytology of clear cell carcinoma of the gallbladder with hepatic infiltration: a case report. Acta Cytol. 2004 Jul-Aug. 48(4):560-4. [Medline].

  28. Winter SS, Rose E, Katz R. Hyperammonemia after chemotherapy in an adolescent with hepatocellular carcinoma. J Pediatr Gastroenterol Nutr. 1997 Nov. 25(5):537-40. [Medline].

  29. Young JL Jr, Miller RW. Incidence of malignant tumors in U. S. children. J Pediatr. 1975 Feb. 86(2):254-8. [Medline].

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