What is a malignant liver tumour?

Malignant liver tumours in children are rare. There are two main types, hepatoblastoma, which usually occurs in children under five years, and hepatocellular carcinoma (HCC), which occur in older children and adolescents.

Signs and symptoms

The most common symptom is an abdominal mass or abdominal distension, which may sometimes be accompanied by pain. Other less common symptoms are loss of appetite, vomiting, weight loss and lethargy. Rarely jaundice (a yellowish tinge to the skin or whites of the eyes) may occur.

Diagnosis

Investigations will include abdominal and lung CT scans and usually an MRI scan. These scans show the size and site of the tumour within the liver and whether the tumour has spread to the lungs. Most hepatoblastomas and some HCC produce alpha-fetoprotein (AFP) which can be measured in the blood. If the AFP is raised, it can be used to monitor response to treatment. A biopsy of the tumour will be necessary to confirm the diagnosis before treatment is commenced. Blood tests are taken to measure kidney and liver function. 

Treatment

Occasionally complete surgical resection alone is required, but most cases require chemotherapy to reduce the size of the tumour to enable it to be surgically removed. The size and extent of the tumour will determine how much chemotherapy is to be given. The outcome for hepatoblastoma in children is usually very favourable even in the presence of metastatic disease. Outcomes for HCC are more guarded. 

Follow-up care

Follow-up care involves regular clinical examinations, blood tests to measure the level of AFP as well as scans and chest X-rays. After the first few years the focus of follow up changes to monitoring growth and development and other possible later side effects of treatment.