Pediatric Hepatocellular Carcinoma Treatment & Management
- Author: Paulette Mehta, MD, MPH; Chief Editor: Max J Coppes, MD, PhD, MBA more...
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.
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.
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.
Vitamin K supplementation may help patients with a coagulation defect.
Activity depends on the overall health of the individual after surgery or chemotherapy.
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