Medscape is available in 5 Language Editions – Choose your Edition here.


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.


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.



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.

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].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.