Hepatocellular Carcinoma (HCC)

What Is Hepatocellular Carcinoma (HCC)?

Hepatocellular carcinoma (HCC) is a type of liver cancer. It is the second most common liver cancer in children.

What Are the Signs & Symptoms of Hepatocellular Carcinoma (HCC)?

Hepatocellular (hep-uh-toe-SEL-yuh-ler) carcinoma often affects teenagers, but also can happen in younger children, especially those who have an underlying liver disease.

A child who has it might have these symptoms:

• a large belly that sticks out
• belly pain, most often on the right side
• belly mass (something solid in the belly that can be felt through the skin)
• jaundice (yellow skin or eyes)
• back pain
• a fever
• itching
• loss of appetite
• weight loss
• nausea and vomiting 
• anemia (low red blood cell count)

What Causes Hepatocellular Carcinoma (HCC)?

Doctors don't know the exact cause of hepatocellular carcinoma. It happens most commonly in children whose liver is normal. Some children who have viral infections or other conditions that cause liver inflammation (swelling and irritation), like viral hepatitis, get HCC more often than other children.

Other less common causes or triggers include:

• hereditary tyrosinemia (when a protein called tyrosine builds up in the body)
• hereditary hemochromatosis (when excess iron is stored in the liver)
• Wilson disease
• progressive hepatic cholestasis (when the flow of bile from the liver is reduced)

How Is Hepatocellular Carcinoma (HCC) Diagnosed?

When a child might have hepatocellular carcinoma, the doctor will do an exam. Tests done may include:

• blood tests, including liver and kidney function tests and an alpha fetoprotein (AFP) test (liver damage and some cancers can raise the level of this protein in the blood)
• imaging tests:
  • ultrasound
  • X-rays
  • CAT scan
• a biopsy: removing a piece of tumor tissue for examination or testing

How Is Hepatocellular Carcinoma (HCC) Treated?

Doctors usually treat hepatocellular carcinoma with a combination of surgery and chemotherapy. If possible, children with cancer should go to a medical center specializing in the treatment of pediatric cancers.

Treatment depends on:

• the child's age
• the size of the tumor
• whether there is one or many tumors in the liver
• whether the cancer has spread from the liver

Treatment Options

Surgery is the most important part of treatment, but many HCC tumors cannot be removed easily. A liver transplant may be considered because the whole liver needs to be removed to get the entire tumor out.

Chemotherapy is often used but is not very effective in shrinking HCC.

Radioembolization (or Y90) is a type of therapy that delivers high-dose radiation directly to the liver tumor through the bloodstream. The radiologist inserts a tiny catheter (plastic tube) in the groin and passes it to the artery closest to the tumor. This procedure protects much of the normal liver tissue from the effects of Y90.

Y90 can be used as primary therapy in liver tumors that don't respond well to chemotherapy. It's also used when the tumors come back or don't shrink enough for surgery.

Transarterial chemoembolization (TACE), which sends chemotherapy particles directly to the tumor.

Tumor ablation, which is when doctors destroy tumors by using small needles to heat or cool them.

Who Treats Hepatocellular Carcinoma (HCC)?

HCC is treated by a health care team, including specialists in:

• oncology (cancer)/hematology (blood diseases)
• surgery
• interventional radiology (image-guided minimally invasive procedures)
• gastroenterology (digestive tract) and hepatology (liver)
• pathology (diagnosing diseases by examining body tissues, fluids and organs)
• genetics (genetic counseling and testing)
• radiology (medical imaging)
• nutrition

What Else Should I Know?

Hepatocellular carcinoma is challenging to treat, even before it spreads beyond the liver. Clinical trials are underway to help find better treatments in children and adults.

After treatment, a child will have frequent checkups with the care team especially because there is a possibility that the cancer may return.

Having a child being treated for cancer can feel overwhelming for any family. But you're not alone. To find support, talk to your child's doctor or a hospital social worker. Many resources are available to help you get through this difficult time.

You also can find information and support online at:

• National Cancer Institute
• American Childhood Cancer Organization
• American Liver Foundation