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Pediatric Hepatocellular Carcinoma Treatment & Management

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

Medical Care

Hepatocellular carcinoma (HCC) is most easily treated in its earliest stages of presentation. Because patients often present with advanced disease, for which treatment modalities are limited at best, recent emphasis has been placed on screening for hepatocellular carcinoma in at-risk patients. Patients with chronic hepatitis B have a relative risk for developing hepatocellular carcinoma that is 100-fold greater than that of uninfected persons. Currently, patients with chronic hepatitis B or C are recommended to have an annual α -fetoprotein level obtained. If the level is 29 ng/mL or more, continued surveillance is recommended at least annually.

Ultrasonography is also recommended at similar intervals for patients who are at risk. Suspicious lesions warrant biopsy; however, in patients who are found to have a lesion larger than 2 cm and an α -fetoprotein level in excess of 200 ng/mL, biopsy may not be necessary because the chance of hepatocellular is virtually 100% in these cases.

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Surgical Care

Surgical resection must be undertaken by a surgeon familiar with liver tumor management. Underlying coagulation defects may complicate the surgery. Pathologic analysis that shows no remaining cells is the goal of resection. Although the liver is capable of regeneration, overly aggressive resection may predispose the patient to liver failure and death. Transarterial embolization and chemoembolization have been used with limited success.

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Consultations

Management by a pediatric oncology healthcare team is required. This team should include individuals from the following areas of specialty: surgery, psychiatry, radiation oncology, infectious disease, metabolic disorders, diagnostic radiology, pharmacy, nursing specialists, and social work.

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Diet

Vitamin K supplementation may help patients with a coagulation defect.

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Activity

Activity depends on the overall health of the individual after surgery or chemotherapy.

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Contributor Information and Disclosures
Author

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.

Acknowledgements

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.

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