Pediatric Hepatocellular Carcinoma Treatment & Management

Updated: Mar 12, 2020
  • Author: Paulette Mehta, MD, MPH; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Treatment

Medical and Surgical Care

Medical care

Hepatocellular carcinoma (HCC) is most easily treated in its earliest stages. Because patients often present with advanced disease, for which treatment modalities are limited at best, emphasis has been placed on screening for hepatocellular carcinoma in at-risk patients. Patients with chronic hepatitis B have a relative risk of developing hepatocellular carcinoma that is 100-fold greater than that of uninfected persons. [6] Thus, patients with chronic hepatitis B or hepatitis C are recommended to have an α-fetoprotein level obtained each year. If the level is 29 ng/mL or higher, 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 likelihood of hepatocellular carcinoma 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.

Consultations

Management by a pediatric oncology health care team is required. This team should include individuals from the following areas of specialty:

  • Diagnostic radiology
  • Infectious diseases
  • Metabolic disorders
  • Nursing
  • Pharmacy
  • Psychiatry
  • Radiation oncology
  • Social work
  • Surgery
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Further Inpatient Care

Follow-up of patients with hepatocellular carcinomas (HCCs) varies. For the child who requires only surgery, good postoperative management of the surgical site and assessment of liver function tests may be sufficient. If the α-fetoprotein or vitamin 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- 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.

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Diet and Activity

Diet

Vitamin K supplementation may help patients with a coagulation defect.

Activity

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

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