Children's Cancer

Liver tumours start in cells in the liver. There are several types of liver tumours that affect children.

Hepatoblastoma usually occurs in children under three years of age, but doesn’t usually spread to other parts of the body.

Hepatocellular carcinoma usually occurs in older children and teenagers. It often spreads to other parts of the body.

Undifferentiated embryonal sarcoma of the liver usually occurs in children aged five to 10. It often spreads throughout the liver, or to the lungs.

Infantile choriocarcinoma starts in the placenta while the baby is in the womb. It’s usually diagnosed in the first few months of life. It’s extremely rare for the mother to be affected as well.¹

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145388/

Chance of a cure

One of you biggest concerns on learning your child has cancer is whether they can be cured. Older children are likely to share these concerns. It is important to reassure them that doctors expect to cure most children with cancer.

Due to major advances in treatment, many children treated for cancer now survive into adulthood. Children diagnosed with cancer between 2004 and 2012 have a 5-year survival rate of 85%. In the 1980s, the 5-year survival rate for all cancers was about 73%.¹

Talk to your child’s doctor about your child’s diagnosis, treatments and long-term survival. Long-term survival is also called the outlook or prognosis. It on depends several things, including:

• age of your child at diagnosis
• extent or stage of the cancer
• how the cancer cells look under a microscope (the shape, function and structure of the cells)
• how the cancer responds to treatment
• cancer or tumour biology, which includes
  • the patterns of the cancer cells
  • how different the cancer cells are from normal cells
  • how fast the cancer cells are growing.

To learn more about survival for liver (hepatic) tumours children, visit Australian Cancer Childhood Statistics Online.

References

[1] https://cancerqld.blob.core.windows.net/content/docs/Childhood-Cancer-in-Australia-1983-2015.pdf

Clinical trials

It’s possible that your child may be able to be part of a clinical trial. Clinical trials are research investigations to test new treatments, interventions or tests, as a way to prevent, detect, treat, or manage various diseases or medical conditions. The patients involved in clinical trials are volunteers.¹

With regard to cancer, researchers run clinical trials to test new ways to:

• treat cancer
• find and diagnose cancer
• manage cancer symptoms and treatment side effects.

If a trial is available, taking part in one will be entirely the family’s decision

It’s important to note that any new treatments are strictly regulated and must be approved before they can be used in a clinical trial. Your child’s doctor will explain everything about the trial and give you detailed written information. If you wish your child to be part of the trial, you will need to give permission.

Participating in a clinical trial may or may not directly benefit your child. However, the results of clinical trials today help children with cancer in the future. If you’re interested in participating in a clinical trial, ask your child’s doctor if there are any suitable for your child.

You can find further information on our Clinical trials and research page.

References

[1] https://www.australianclinicaltrials.gov.au/what-clinical-trial

Diagnosis

When your child is diagnosed with cancer, it can feel overwhelming. This phase involves finding out if your child has cancer and determining the type of cancer they have. Children’s cancer can be difficult to diagnose, as many symptoms are similar to those caused by less serious conditions or injuries. This means that your child may need several tests and medical appointments before you receive confirmation that your child has cancer.

If your doctor thinks your child has a liver tumour, your child will have several tests, which may include:

• Medical history and physical exam
• Blood tests
• Urine tests
• Medical imaging, such as
  • X-ray
  • Ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
• Biopsy, with tests for genetic changes to help find the best way to treat your child.

Our section, How is cancer diagnosed? explains these tests in more detail.

Staging

Doctors use staging to describe how much the cancer has grown. Some of the tests will help to stage the tumour (Cancer). Staging determines:

• Where the tumour is located within the liver
• The size of the tumour if the tumour has spread to other parts of the body

Your doctor will use this information to determine the best way to treat the disease. Staging will also give your doctor an idea of how well these treatments are likely to work (prognosis).

Treatment for children with liver tumours generally first requires chemotherapy. Surgery is performed at a later date. Surgery might include liver transplantation because of the size and location of the tumour within the liver. The decision to use liver transplantation requires very careful and accurate staging both before the start of chemotherapy and before surgery

Liver cancer staging uses medical imaging scans to see how far the cancer has spread within the liver.

Doctors then describe four stages after surgery:

• Stage I – the cancer had not spread outside the liver. Surgery removed it fully.
• Stage II – the cancer had not spread outside the liver. Some cancer cells remain after surgery. Doctors can see them under a microscope.
• Stage III – surgery cannot remove the cancer. In a second option, visible cancer remains after surgery. In a third variation, the cancer has spread from the liver to nearby lymph nodes.
• Stage IV – the cancer has spread to other parts of the body. These may include the lungs or brain.

References

[1] https://www.pedrad.org/Portals/5/Subspecialties/Abdominal%20Imaging/PRETEXT%202017.pdf?ver=2018-07-09-155954-130

Risk factors

A risk factor is anything that increases a person’s chance of getting a certain condition or disease. Researchers know about some risk factors that increase the chance of developing cancer. However, for most children with cancer, the cause is unknown.

What we do know is that if a child develops cancer, it’s not because of something they, or their parents did to cause it. No one is to blame if a child develops cancer.

Even if your child has a risk factor, it doesn’t mean they will develop cancer. Many children with a risk factor will never develop cancer, most children with cancer have no known risk factors. Even if a child with a risk factor develops cancer, the risk factor may not have had much to do with it.

Researchers don’t completely understand what causes liver tumours. However, some things have been linked to a higher chance of getting liver tumours.

Genetic conditions

Research links several genetic conditions with hepatoblastoma. They include:

• Aicardi syndrome
• Beckwith–Wiedemann syndrome
• familial adenomatous polyposis
• hemihyperplasia.

Research also links hepatocellular carcinoma with genetic conditions that affect the liver, including:

• Alagille syndrome
• glycogen storage disease
• tyrosinaemia
• progressive familial intrahepatic disease.

If your child has one of these genetic conditions, they will need specific care. Your health care team will talk to you about which ongoing tests your child will need.

Childhood cancers that have links to genetic conditions may also affect the risk for other family members. You can ask your child’s treatment team if you or your family should get genetic counselling.

To learn more about genetic conditions, see the children’s cancer glossary or the Centre for Genetics Education.

Certain virus infections

Mothers with the hepatitis B virus can infect their children during birth. Children who are infected have a higher chance of getting hepatocellular carcinoma, a type of liver cancer that is more common in adults than children.

Other factors

A child with a very low birth weight has an increased risk of getting a hepatoblastoma.

Biliary cirrhosis (a type of chronic liver disease) can increase a child’s risk of getting hepatocellular carcinoma.

Males have a higher chance of getting hepatocellular carcinoma than females.

Support and more information

A diagnosis of cancer in a child is difficult for you and your family. It’s normal for you and your family to feel overwhelmed, scared, anxious or angry.

If you or others around you are having trouble coping, make sure you speak to your child’s treatment team. They have helped and supported many other families who have been through what you’re currently going through. Sometimes just letting other people know how you’re feeling helps you feel less alone. If you feel supported, then you will feel more able to support your child.

Most children’s hospitals will allocate a social worker to each family to provide support throughout treatment. If you need support, contact your hospital-based social worker to let them know how you’re feeling and to see what support can be made available to you and your family, including music therapists, play therapists or education support staff.

The following webpages and organisations also offer support and/or extra information for kids with cancer and their families:

• Living with children’s cancer has information about physical, emotional and practical issues during and after diagnosis and treatment. 
• Organisations that can provide support and information.
• Redkite is a national organisation that provides emotional support, financial assistance, information and resources to families who have a child with cancer. You can reach them through their support line 1800 733 548 (1800 REDKITE), which is open (9am-7pm AEST), email support@redkite.org.au or live chat on www.redkite.org.au
• Canteen provides a service called Canteen Connect, an online community for young people aged 12-25 dealing with their own or a close family member’s cancer, and Parent Connect, an online community with resources, information and peer support on parenting through cancer. Online counselling is available seven days a week, including evenings. Visit https://canteenconnect.org or call 1800 835 932.
• The Cancer Council in your state or territory can give you: 
  • general information about cancer 
  • information on resources and support groups in your area. 
  • Call the Cancer Council Helpline from anywhere in Australia on 13 11 20.
• Any of the major children’s hospitals and networks in your state or territory can provide information about childhood cancer.

For more information about childhood liver tumours, see:

• Childhood liver cancer treatment (PDQ®), from the National Cancer Institute (United States) 
• Childhood liver tumours, from Rare Cancers Australia.

Note that information from international organisations may not always apply to children in Australia.

Symptoms

Many conditions can cause the symptoms below, not just cancer. If your child has any of these symptoms and you are worried, talk to your child’s doctor. The earlier cancer is found, the better.

Symptoms of liver tumours may include:

• a lump, pain or swelling in the belly
• loss of appetite
• weight loss
• unusual tiredness
• yellowing of the skin and the whites of the eyes – this is called jaundice
• nausea and vomiting.

Treatment

Your team of doctors, called a multidisciplinary team (MDT), will care for and treat your child, and will ensure that all your child’s needs are considered while they have cancer treatment. The section called The treatment team has further information about this.

Treatment for liver tumours depends on:

• the age of your child
• the stage of the cancer
• other factors.

Doctors will suggest treatments based on your child’s situation. Treatment may involve one or more of the following:

• surgery
• chemotherapy
• radiation therapy
• targeted therapy
• other treatments.

Surgery

Most children with a liver tumour have surgery to remove all or part of the liver. If their whole liver is removed, they will also need a liver transplant.

See How is cancer treated – surgery for more detail about cancer surgery.