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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65879_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65879_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65879_"><span class="title" itemprop="name">Childhood Liver Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: June 30, 2016.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000258119__366">This PDQ cancer information summary has current information about the treatment of childhood liver cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000258119__367">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000258119__1"><h2 id="_CDR0000258119__1_">General Information About Childhood Liver Cancer</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258119__2">Childhood liver cancer is a disease in which malignant (cancer) cells form in
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the tissues of the liver.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__351">There are different types of childhood liver cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__7">Certain diseases and disorders can increase the risk of childhood liver cancer. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__15">Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__19">Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__23">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000258119__2"><h3>Childhood liver cancer is a disease in which malignant (cancer) cells form in
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the tissues of the liver.</h3><p id="CDR0000258119__4"> The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> is one of the largest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the body. It has four <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046188/" class="def">lobes</a> and fills the upper right side of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> inside the rib cage. Three of the many important functions of the liver are:</p><ul id="CDR0000258119__198"><li class="half_rhythm"><div>To <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748828/" class="def">filter</a> harmful substances from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> so they can be passed from the body in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stools</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a>.</div></li><li class="half_rhythm"><div>To make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046508/" class="def">bile</a> to help <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digest</a> fats from food. </div></li><li class="half_rhythm"><div>To store glycogen (sugar), which the body uses for energy. </div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119271" co-legend-rid="figlgndCDR0000258119271"><a href="/books/NBK65879.5/figure/CDR0000258119__271/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119271" rid-ob="figobCDR0000258119271"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000659745.gif" src-large="/books/NBK65879.5/bin/CDR0000659745.jpg" alt="Anatomy of the liver" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119271"><h4 id="CDR0000258119__271"><a href="/books/NBK65879.5/figure/CDR0000258119__271/?report=objectonly" target="object" rid-ob="figobCDR0000258119271">Figure</a></h4><p class="float-caption no_bottom_margin">Anatomy of the liver. The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas. The liver has four lobes. Two lobes are on the front and two small lobes (not shown) are on the back of the liver. </p></div></div><p id="CDR0000258119__114"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">Liver cancer</a> is rare in children and adolescents. </p></div><div id="CDR0000258119__351"><h3>There are different types of childhood liver cancer.</h3><p id="CDR0000258119__353">There are two main types of childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a>:</p><ul id="CDR0000258119__354"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046160/" class="def">Hepatoblastoma</a>: Hepatoblastoma is the most common type of childhood liver cancer. It usually affects children younger than 3 years of age. </div><div class="half_rhythm">In hepatoblastoma, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044171/" class="def">histology</a> (how the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> look under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>) affects the way the cancer is treated. The histology for hepatoblastoma may be one of the following:<ul id="CDR0000258119__363"><li class="half_rhythm"><div>Pure <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000712879/" class="def">fetal</a> histology.</div></li><li class="half_rhythm"><div>Small cell <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044775/" class="def">undifferentiated</a> histology.</div></li><li class="half_rhythm"><div>Non-pure fetal histology, non-small cell undifferentiated histology. </div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046363/" class="def">Hepatocellular carcinoma</a>: Hepatocellular carcinoma usually affects older children and adolescents. It is more common in areas of Asia that have high rates of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046371/" class="def">hepatitis</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> than in the U.S.</div></li></ul><p id="CDR0000258119__356">The treatment of two less common types of childhood liver cancer is also discussed in this summary: </p><ul id="CDR0000258119__357"><li class="half_rhythm"><div>Undifferentiated <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367442/" class="def">embryonal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">sarcoma</a> of the liver: This type of liver cancer usually occurs in children between 5 and 10 years of age. It often spreads all through the liver and/or to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.</div></li><li class="half_rhythm"><div>Infantile <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046753/" class="def">choriocarcinoma</a> of the liver is a very rare <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> that starts in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045017/" class="def">placenta</a> and spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046400/" class="def">fetus</a>. The tumor is usually found during the first few months of life. Also, the mother of the child may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> with choriocarcinoma. Choriocarcinoma is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046199/" class="def">gestational trophoblastic disease</a> and needs treatment. See the <a href="/books/n/pdqcis/CDR0000062699/">Gestational Trophoblastic Disease Treatment</a> summary for information on the treatment of choriocarcinoma. </div></li></ul><p id="CDR0000258119__358">Epithelioid hemangioendothelioma is a rare <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> that occurs in the liver and other organs. See the <a href="/books/n/pdqcis/CDR0000258672/#CDR0000258672__454">Epithelioid hemangioendothelioma</a> section in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000258672/">Childhood Soft Tissue Sarcoma Treatment</a> for more information.</p><p id="CDR0000258119__359">This summary is about the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary</a> liver cancer (cancer that begins in the liver). Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary. Primary liver cancer can occur in both adults and children. However, treatment for children is different than treatment for adults. See the PDQ summary on <a href="/books/n/pdqcis/CDR0000256491/">Adult Primary Liver Cancer Treatment</a> for more information on the treatment of adults.</p></div><div id="CDR0000258119__7"><h3>Certain diseases and disorders can increase the risk of childhood liver cancer. </h3><p id="CDR0000258119__140">Anything that increases your chance of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk. </p><p id="CDR0000258119__304">Risk factors for hepatoblastoma include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndromes</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000258119__158"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764137/" class="def">Aicardi syndrome</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304689/" class="def">Beckwith-Wiedemann syndrome</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045100/" class="def">Familial adenomatous polyposis</a> (FAP).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748984/" class="def">Glycogen storage disease</a>.</div></li><li class="half_rhythm"><div>A very low weight at birth.</div></li><li class="half_rhythm"><div>Simpson-Golabi-Behmel syndrome.</div></li><li class="half_rhythm"><div>Certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a> changes, such as Trisomy 18.</div></li></ul><p id="CDR0000258119__159">Risk factors for hepatocellular carcinoma include the following syndromes or conditions:</p><ul id="CDR0000258119__136"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748982/" class="def">Alagille syndrome</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748984/" class="def">Glycogen storage disease</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046146/" class="def">Hepatitis B virus</a> infection that was passed from mother to child at birth.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748979/" class="def">Progressive familial intrahepatic disease</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748977/" class="def">Tyrosinemia</a>.</div></li></ul><p id="CDR0000258119__308">Some patients with tyrosinemia or progressive familial intrahepatic disease will have a liver <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> before there are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of cancer.</p></div><div id="CDR0000258119__15"><h3>Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen. </h3><p id="CDR0000258119__17">Signs and symptoms are more common after the tumor gets big. Other conditions can cause the same signs and symptoms. Check with your child’s doctor if your child has any of the following:</p><ul id="CDR0000258119__18"><li class="half_rhythm"><div>A lump in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> that may be painful.</div></li><li class="half_rhythm"><div>Swelling in the abdomen.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>.</div></li></ul></div><div id="CDR0000258119__19"><h3>Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.</h3><p id="CDR0000258119__21">The following tests and procedures may be used:</p><ul id="CDR0000258119__22"><li class="half_rhythm"><div class="half_rhythm">
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354469/" class="def">Serum tumor marker test</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a>, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor markers</a>. The blood of children who have liver cancer may have increased amounts of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormone</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354453/" class="def">beta-human chorionic gonadotropin</a> (β-hCG) or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> (AFP). Other cancers and certain noncancer conditions, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045478/" class="def">cirrhosis</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046371/" class="def">hepatitis</a>, can also increase AFP levels.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">Complete blood
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count</a> (CBC)</b>: A procedure in which a sample of blood is drawn and
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checked for the following:
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<dl id="CDR0000258119__204" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>, and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the protein that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a>) in
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the red blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The portion of the blood sample made up of red blood
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cells.</p></dd></dl></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390293/" class="def">Liver function tests</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver damage or cancer.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044518/" class="def">bilirubin</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354462/" class="def">lactate dehydrogenase</a> (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
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</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045684/" class="def">Epstein-Barr virus</a> (EBV) test</b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688783/" class="def">blood test</a> to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to the EBV and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a> of the EBV. These are found in the blood of patients who have been infected with EBV.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Hepatitis <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044528/" class="def">assay</a></b>: A procedure in which a blood sample is checked for pieces of the hepatitis <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">virus</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging) with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597153/" class="def">gadolinium</a></b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the liver. A substance called gadolinium is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a>. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119368" co-legend-rid="figlgndCDR0000258119368"><a href="/books/NBK65879.5/figure/CDR0000258119__368/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119368" rid-ob="figobCDR0000258119368"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000775532.gif" src-large="/books/NBK65879.5/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) of the abdomen" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119368"><h4 id="CDR0000258119__368"><a href="/books/NBK65879.5/figure/CDR0000258119__368/?report=objectonly" target="object" rid-ob="figobCDR0000258119368">Figure</a></h4><p class="float-caption no_bottom_margin">Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer. </p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. The picture can be printed to be looked at later. In childhood liver cancer, an ultrasound exam of the abdomen to check the large blood vessels is usually done.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119369" co-legend-rid="figlgndCDR0000258119369"><a href="/books/NBK65879.5/figure/CDR0000258119__369/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119369" rid-ob="figobCDR0000258119369"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000775457.gif" src-large="/books/NBK65879.5/bin/CDR0000775457.jpg" alt="Abdominal ultrasound" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119369"><h4 id="CDR0000258119__369"><a href="/books/NBK65879.5/figure/CDR0000258119__369/?report=objectonly" target="object" rid-ob="figobCDR0000258119369">Figure</a></h4><p class="float-caption no_bottom_margin">Abdominal ultrasound. An ultrasound transducer connected to a computer is pressed against the skin of the abdomen. The transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture). </p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. In childhood liver cancer, a CT scan of the chest and abdomen is usually done.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119370" co-legend-rid="figlgndCDR0000258119370"><a href="/books/NBK65879.5/figure/CDR0000258119__370/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119370" rid-ob="figobCDR0000258119370"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000775531.gif" src-large="/books/NBK65879.5/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan of the abdomen" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119370"><h4 id="CDR0000258119__370"><a href="/books/NBK65879.5/figure/CDR0000258119__370/?report=objectonly" target="object" rid-ob="figobCDR0000258119370">Figure</a></h4><p class="float-caption no_bottom_margin">Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen. </p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">Abdominal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a></b>: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div class="half_rhythm">
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of a sample of cells or tissues so it can be viewed under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to check for signs of cancer. The sample may be taken during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove or view the tumor. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> looks at the sample under a microscope to find out the type of liver cancer. </div><div class="half_rhythm">The following test may be done on the sample of tissue that is removed:<dl id="CDR0000258119__307" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> in a sample of tissue. The antibody is usually linked to a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance or a dye that causes the tissue to light up under a microscope. This type of test is used to check for a certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutation</a> and to tell the difference between different types of cancer.</p></dd></dl></div></li></ul></div><div id="CDR0000258119__23"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000258119__184">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options for hepatoblastoma depend on the following:
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</p><ul id="CDR0000258119__185"><li class="half_rhythm"><div>The <a href="#CDR0000258119__287">PRETEXT or POSTTEXT</a> group.</div></li><li class="half_rhythm"><div>Whether the cancer has spread to other places in the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.
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</div></li><li class="half_rhythm"><div>Whether the cancer can be removed completely by surgery.</div></li><li class="half_rhythm"><div>How the cancer responds to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>How the cancer cells look under a microscope.</div></li><li class="half_rhythm"><div>Whether the AFP blood levels go down after treatment.</div></li><li class="half_rhythm"><div>Whether the cancer has just been <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a>.
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</div></li></ul><p id="CDR0000258119__336">The prognosis (chance of recovery) and treatment options for hepatocellular carcinoma depend on the following:</p><ul id="CDR0000258119__339"><li class="half_rhythm"><div>The <a href="#CDR0000258119__287">PRETEXT or POSTTEXT</a> group.</div></li><li class="half_rhythm"><div>Whether the cancer has spread to other places in the body, such as the lungs.
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</div></li><li class="half_rhythm"><div>Whether the cancer can be removed completely by surgery.</div></li><li class="half_rhythm"><div>How the cancer responds to chemotherapy.</div></li><li class="half_rhythm"><div>How the cancer cells look under a microscope.</div></li><li class="half_rhythm"><div>Whether the child has hepatitis B infection.</div></li><li class="half_rhythm"><div>Whether the cancer has just been diagnosed or has recurred.
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</div></li></ul><p id="CDR0000258119__309">For childhood liver cancer that recurs (comes back) after initial treatment, the prognosis and treatment options depend on:</p><ul id="CDR0000258119__310"><li class="half_rhythm"><div>Where in the body the tumor recurred.</div></li><li class="half_rhythm"><div>The type of treatment used to treat the initial cancer.</div></li></ul><p id="CDR0000258119__187">Childhood liver cancer may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318813/" class="def">cured</a> if the tumor is small and can be completely removed by surgery. Complete removal is possible more often for hepatoblastoma than for hepatocellular carcinoma.</p></div></div><div id="CDR0000258119__26"><h2 id="_CDR0000258119__26_">Stages of Childhood Liver Cancer</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258119__27">After childhood liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__281">There are two grouping systems for childhood liver cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__287">There are four PRETEXT and POSTTEXT groups:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__216">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__320">Cancer may spread from where it began to other parts of the body.</a></div></li></ul></div><div id="CDR0000258119__27"><h3>After childhood liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. </h3><p id="CDR0000258119__29">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, or to other
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parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. In childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a>, the PRETEXT and POSTTEXT groups are used instead of stage to plan treatment. The results of the <a href="#CDR0000258119__19">tests and procedures</a> done to detect, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a>, and find out whether the cancer has spread are used to determine the PRETEXT and POSTTEXT groups.</p></div><div id="CDR0000258119__281"><h3>There are two grouping systems for childhood liver cancer.</h3><p id="CDR0000258119__283">Two grouping systems are used for childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a>:</p><ul id="CDR0000258119__284"><li class="half_rhythm"><div>The PRETEXT group describes the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<i>before</i> the patient has treatment.</div></li><li class="half_rhythm"><div>The POSTTEXT group describes the tumor <i>after</i> the patient has treatment.</div></li></ul></div><div id="CDR0000258119__287"><h3>There are four PRETEXT and POSTTEXT groups:</h3><p id="CDR0000258119__285">The liver is divided into 4 sections. The PRETEXT and POSTTEXT groups depend on which sections of the liver have cancer.</p><div id="CDR0000258119__167"><h4>PRETEXT and POSTTEXT Group I</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119292" co-legend-rid="figlgndCDR0000258119292"><a href="/books/NBK65879.5/figure/CDR0000258119__292/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119292" rid-ob="figobCDR0000258119292"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000686670.gif" src-large="/books/NBK65879.5/bin/CDR0000686670.jpg" alt="Liver PRETEXT I" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119292"><h4 id="CDR0000258119__292"><a href="/books/NBK65879.5/figure/CDR0000258119__292/?report=objectonly" target="object" rid-ob="figobCDR0000258119292">Figure</a></h4><p class="float-caption no_bottom_margin">Liver PRETEXT I. Cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them. </p></div></div><p id="CDR0000258119__169">In group I, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in one section of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>. Three sections of the liver that are next to each other do not have cancer in them.</p></div><div id="CDR0000258119__170"><h4>PRETEXT and POSTTEXT Group II</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119293" co-legend-rid="figlgndCDR0000258119293"><a href="/books/NBK65879.5/figure/CDR0000258119__293/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119293" rid-ob="figobCDR0000258119293"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000686671.gif" src-large="/books/NBK65879.5/bin/CDR0000686671.jpg" alt="Liver PRETEXT II" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119293"><h4 id="CDR0000258119__293"><a href="/books/NBK65879.5/figure/CDR0000258119__293/?report=objectonly" target="object" rid-ob="figobCDR0000258119293">Figure</a></h4><p class="float-caption no_bottom_margin">Liver PRETEXT II. Cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them. </p></div></div><p id="CDR0000258119__172">In group II, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in one or two sections of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>. Two sections of the liver that are next to each other do not have cancer in them.</p></div><div id="CDR0000258119__173"><h4>PRETEXT and POSTTEXT Group III</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119294" co-legend-rid="figlgndCDR0000258119294"><a href="/books/NBK65879.5/figure/CDR0000258119__294/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119294" rid-ob="figobCDR0000258119294"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000686673.gif" src-large="/books/NBK65879.5/bin/CDR0000686673.jpg" alt="Liver PRETEXT III" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119294"><h4 id="CDR0000258119__294"><a href="/books/NBK65879.5/figure/CDR0000258119__294/?report=objectonly" target="object" rid-ob="figobCDR0000258119294">Figure</a></h4><p class="float-caption no_bottom_margin">Liver PRETEXT III. Cancer is found in three sections of the liver and one section does not have cancer, or cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them. </p></div></div><p id="CDR0000258119__175">In group III, one of the following is true:</p><ul id="CDR0000258119__291"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found in three sections of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> and one section does not have cancer.</div></li><li class="half_rhythm"><div>Cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.</div></li></ul></div><div id="CDR0000258119__176"><h4>PRETEXT and POSTTEXT Group IV</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258119295" co-legend-rid="figlgndCDR0000258119295"><a href="/books/NBK65879.5/figure/CDR0000258119__295/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258119295" rid-ob="figobCDR0000258119295"><img class="small-thumb" src="/books/NBK65879.5/bin/CDR0000686674.gif" src-large="/books/NBK65879.5/bin/CDR0000686674.jpg" alt="Liver PRETEXT IV" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258119295"><h4 id="CDR0000258119__295"><a href="/books/NBK65879.5/figure/CDR0000258119__295/?report=objectonly" target="object" rid-ob="figobCDR0000258119295">Figure</a></h4><p class="float-caption no_bottom_margin">Liver PRETEXT IV. Cancer is found in all four sections of the liver. </p></div></div><p id="CDR0000258119__178">In group IV,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in all four sections of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</p></div></div><div id="CDR0000258119__216"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000258119__216_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000258119__216_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000258119__320"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000258119__320_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000258119__320_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000258119__322">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor is the same type of cancer as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>. For example, if childhood liver cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">lung cancer</a>.</p></div></div><div id="CDR0000258119__48"><h2 id="_CDR0000258119__48_">Recurrent Childhood Liver Cancer</h2><p id="CDR0000258119__49"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a> is cancer that has recurred (come back) after it has been treated. The cancer may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or in other parts of the body. Cancer that is growing or worsening during treatment is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045850/" class="def">progressive disease</a>. </p></div><div id="CDR0000258119__50"><h2 id="_CDR0000258119__50_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258119__51">There are different types of treatment for patients with childhood liver cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__142">Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__211">Some cancer treatments cause side effects months or years after treatment has ended.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__55">Five types of standard treatment are used:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__79">New types of treatment are being tested in clinical trials.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__218">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__220">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258119__222">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258119__51"><h3>There are different types of treatment for patients with childhood liver cancer.</h3><p id="CDR0000258119__53">Different types of treatments are available for children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.</p><p id="CDR0000258119__54">Taking part in a clinical trial should be considered for all children with liver cancer. Some clinical trials are open only to patients who have not started treatment. </p></div><div id="CDR0000258119__142"><h3>Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.</h3><p id="CDR0000258119__144">Treatment will be overseen by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric oncologist</a>, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">healthcare providers</a> who are experts in treating children with liver cancer and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. It is especially important to have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318823/" class="def">pediatric surgeon</a> with experience in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> who can send patients to a liver <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> program if needed. Other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a> may include the following:</p><ul id="CDR0000258119__145"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation
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oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li></ul></div><div id="CDR0000258119__211"><h3>Some cancer treatments cause side effects months or years after treatment has ended.
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</h3><p id="CDR0000258119__213"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">Side effects</a> from cancer treatment that begin during or after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of cancer treatment may include:
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</p><ul id="CDR0000258119__214"><li class="half_rhythm"><div>Physical problems.
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</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer).</div></li></ul><p id="CDR0000258119__215">Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a> for more information).
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</p></div><div id="CDR0000258119__55"><h3>Five types of standard treatment are used:</h3><div id="CDR0000258119__199"><h4>Surgery</h4><p id="CDR0000258119__59">When possible, the cancer is removed by surgery.</p><ul id="CDR0000258119__126"><li class="half_rhythm"><div>Partial <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044562/" class="def">hepatectomy</a>: Removal of the part of the liver where cancer is found. The part removed may be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322895/" class="def">wedge</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, an entire <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046188/" class="def">lobe</a>, or a larger part of the liver, along with a small amount of normal tissue around it. </div></li><li class="half_rhythm"><div>Total hepatectomy and liver transplant: Removal of the entire liver followed by a transplant of a healthy liver from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>. A liver transplant may be possible when cancer has not spread beyond the liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046565/" class="def">Resection</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastases</a>: Surgery to remove cancer that has spread outside of the liver, such as to nearby tissues, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, or the brain. </div></li></ul><p id="CDR0000258119__230">Factors that affect the type of surgery used include the following:</p><ul id="CDR0000258119__231"><li class="half_rhythm"><div>The PRETEXT group and POSTTEXT group.</div></li><li class="half_rhythm"><div>The size of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>.</div></li><li class="half_rhythm"><div>Whether there is more than one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> in the liver.</div></li><li class="half_rhythm"><div>Whether the cancer has spread to nearby large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>.</div></li><li class="half_rhythm"><div>The level of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046208/" class="def">alpha-fetoprotein</a> (AFP) in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>.</div></li><li class="half_rhythm"><div>Whether the tumor can be shrunk by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> so that it can be removed by surgery.</div></li><li class="half_rhythm"><div>Whether a liver transplant is needed.</div></li></ul><p id="CDR0000258119__60">Chemotherapy is sometimes given before surgery, to shrink the tumor and make it easier to remove. This is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045800/" class="def">neoadjuvant therapy</a>.</p><p id="CDR0000258119__360">Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> after surgery to kill any cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</p></div><div id="CDR0000258119__288"><h4>Watchful waiting</h4><p id="CDR0000258119__290"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a> is closely <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454803/" class="def">monitoring</a> a patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> without giving any treatment until <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> appear or change. In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046160/" class="def">hepatoblastoma</a>, this treatment is only used for small tumors that have been completely removed by surgery.</p></div><div id="CDR0000258119__64"><h4>Chemotherapy</h4><p id="CDR0000258119__191">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). Treatment using more than one anticancer drug is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. </p><p id="CDR0000258119__195"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> (the main <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440100/" class="def">artery</a> that supplies <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> to the liver) is a type of regional chemotherapy used to treat childhood liver cancer. The anticancer drug is injected into the hepatic artery through a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheter</a> (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> it needs to grow. The liver continues to receive blood from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044564/" class="def">hepatic portal vein</a>, which carries blood from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a>. This procedure is also called transarterial chemoembolization or TACE.</p><p id="CDR0000258119__361">The way the chemotherapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group. </p></div><div id="CDR0000258119__61"><h4>Radiation therapy</h4><p id="CDR0000258119__63"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000258119__371"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000258119__327">The way the radiation therapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000644772/" class="def">Radioembolization</a> of the hepatic artery (the main artery that supplies blood to the liver) is a type of internal radiation therapy used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046363/" class="def">hepatocellular carcinoma</a>. A very small amount of a radioactive substance is attached to tiny beads that are injected into the hepatic artery through a catheter (thin tube). The beads are mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the radiation is trapped near the tumor to kill the cancer cells. This is done to relieve symptoms and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> for children with hepatocellular carcinoma. External radiation therapy is used to treat hepatoblastoma that cannot be removed by surgery or has spread to other parts of the body.</p></div><div id="CDR0000258119__324"><h4>Antiviral treatment</h4><p id="CDR0000258119__326">Hepatocellular carcinoma that is linked to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046146/" class="def">hepatitis B virus</a> may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046088/" class="def">antiviral</a> drugs.</p></div></div><div id="CDR0000258119__79"><h3>New types of treatment are being tested in clinical trials.</h3><p id="CDR0000258119__299">Information about clinical trials is available from the
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<a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000258119__218"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000258119__218_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000258119__218_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000258119__218_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000258119__220"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000258119__220_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000258119__220_30">Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </p></div><div id="CDR0000258119__222"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258119__364">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the treatment group may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000258119__365">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000258119__89"><h2 id="_CDR0000258119__89_">Treatment Options for Childhood Liver Cancer</h2><div id="CDR0000258119__234"><h3>Hepatoblastoma</h3><p id="CDR0000258119__341">Treatment options for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046160/" class="def">hepatoblastoma</a> that can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> at the time of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> may include the following:</p><ul id="CDR0000258119__342"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">watchful waiting</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>, for hepatoblastoma with pure <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000712879/" class="def">fetal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044171/" class="def">histology</a>.</div></li><li class="half_rhythm"><div>Surgery to remove the tumor, with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> given either before surgery, after surgery, or both, for hepatoblastoma that is not pure fetal histology. For hepatoblastoma with small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cell</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044775/" class="def">undifferentiated</a> histology, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046053/" class="def">aggressive</a> chemotherapy is given.</div></li></ul><p id="CDR0000258119__343">Treatment options for hepatoblastoma that cannot be removed by surgery or is not removed at the time of diagnosis may include the following:</p><ul id="CDR0000258119__344"><li class="half_rhythm"><div>Combination chemotherapy to shrink the tumor, followed by surgery to remove the tumor.</div></li><li class="half_rhythm"><div>Combination chemotherapy followed by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> to shrink the tumor, followed by surgery to remove the tumor.</div></li></ul><p id="CDR0000258119__345">For hepatoblastoma that has spread to other parts of the body at the time of diagnosis, combination chemotherapy is given to shrink the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> in the liver and cancer that has spread to other parts of the body. After chemotherapy, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a> are done to check whether the cancer can be removed by surgery.</p><p id="CDR0000258119__346"> Treatment options may include the following:</p><ul id="CDR0000258119__347"><li class="half_rhythm"><div>If the cancer in the liver and other parts of the body can be removed, surgery will be done to remove the tumors followed by chemotherapy to kill any cancer cells that may remain.</div></li><li class="half_rhythm"><div>If the cancer in the liver cannot be removed by surgery but there are no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of cancer in other parts of the body, the treatment may be a liver transplant. </div></li><li class="half_rhythm"><div>If the cancer in other parts of the body cannot be removed or a liver transplant is not possible, chemotherapy, chemoembolization of the hepatic artery, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> may be given.</div></li></ul><p id="CDR0000258119__349">Treatment options in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a> for newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> hepatoblastoma include:</p><ul id="CDR0000258119__350"><li class="half_rhythm"><div>A clinical trial of new treatment <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimens</a> based on how likely it is the cancer will <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recur</a> after initial treatment.
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</div></li></ul></div><div id="CDR0000258119__247"><h3>Hepatocellular Carcinoma</h3><p id="CDR0000258119__248">Treatment options for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046363/" class="def">hepatocellular carcinoma</a> that can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> at the time of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> may include the following:</p><ul id="CDR0000258119__249"><li class="half_rhythm"><div>Surgery alone to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>.</div></li><li class="half_rhythm"><div> Surgery to remove the tumor, followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> followed by surgery to remove the tumor.</div></li></ul><p id="CDR0000258119__250">Treatment options for hepatocellular carcinoma that cannot be removed by surgery at the time of diagnosis may include the following:</p><ul id="CDR0000258119__251"><li class="half_rhythm"><div>Chemotherapy to shrink the tumor, followed by surgery to completely remove the tumor.</div></li><li class="half_rhythm"><div>Chemotherapy to shrink the tumor. If surgery to completely remove the tumor is not possible, further treatment may include the following:<dl id="CDR0000258119__264" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">Liver</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Chemoembolization of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> to shrink the tumor, followed by surgery to remove as much of the tumor as possible or liver transplant.</p></dd><dt>-</dt><dd><p class="no_top_margin">Chemoembolization of the hepatic artery alone.</p></dd></dl></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000644772/" class="def">Radioembolization</a> of the hepatic artery as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li></ul><p id="CDR0000258119__252">Treatment for hepatocellular carcinoma that has spread to other parts of the body at the time of diagnosis may include:</p><ul id="CDR0000258119__313"><li class="half_rhythm"><div>Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible from the liver and other places where cancer has spread. Studies have not shown that this treatment works well but some patients may have some benefit.</div></li></ul><p id="CDR0000258119__333">Treatment options for hepatocellular carcinoma related to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046146/" class="def">hepatitis B virus</a> (HBV) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> include:</p><ul id="CDR0000258119__335"><li class="half_rhythm"><div>Surgery to remove the tumor.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046088/" class="def">Antiviral</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> that treat infection caused by the hepatitis B virus.</div></li></ul></div><div id="CDR0000258119__259"><h3> Undifferentiated Embryonal Sarcoma of the Liver</h3><p id="CDR0000258119__269">Treatment options for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044775/" class="def">undifferentiated</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367442/" class="def">embryonal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">sarcoma</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> (UESL) may include the following:</p><ul id="CDR0000258119__270"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> to shrink the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove as much of the tumor as possible. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> may also be given after surgery to remove the tumor.</div></li><li class="half_rhythm"><div>Surgery to remove the tumor followed by chemotherapy. A second surgery may be done to remove tumor that remains, followed by more chemotherapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">Liver</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> if surgery to remove the tumor is not possible.</div></li></ul></div><div id="CDR0000258119__273"><h3>Infantile Choriocarcinoma of the Liver</h3><p id="CDR0000258119__274">Treatment options for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046753/" class="def">choriocarcinoma</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> in infants may include the following: </p><ul id="CDR0000258119__314"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> to shrink the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the tumor.</div></li><li class="half_rhythm"><div>Surgery to remove the tumor.</div></li></ul></div><div id="CDR0000258119__261"><h3>Recurrent Childhood Liver Cancer</h3><p id="CDR0000258119__262">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046160/" class="def">hepatoblastoma</a> may include the following:</p><ul id="CDR0000258119__266"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove isolated (single and separate) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">Liver</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new treatment.</div></li></ul><p id="CDR0000258119__267">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045850/" class="def">progressive</a> or recurrent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046363/" class="def">hepatocellular carcinoma</a> may include the following:</p><ul id="CDR0000258119__268"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046708/" class="def">Chemoembolization</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> to shrink the tumor before liver transplant.</div></li><li class="half_rhythm"><div>Liver transplant.</div></li><li class="half_rhythm"><div>A clinical trial of a new treatment.</div></li></ul></div><div id="CDR0000258119__296"><h3>Treatment Options in Clinical Trials</h3><p id="CDR0000258119__TrialSearch_296_18">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=43714&tt=1&format=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">childhood liver cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000258119__206"><h2 id="_CDR0000258119__206_">To Learn More About Childhood Liver Cancer</h2><p id="CDR0000258119__207">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about childhood liver cancer, see the following: </p><ul id="CDR0000258119__297"><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/liver" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Liver and Bile Duct Cancer Home Page</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a></div></li></ul><p id="CDR0000258119__206_44">For more childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other general cancer resources, see the following:</p><ul id="CDR0000258119__206_45"><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="http://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000258119__AboutThis_1"><h2 id="_CDR0000258119__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000258119__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000258119__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="http://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000258119__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000258119__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000258119__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood liver cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000258119__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000258119__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000258119__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000258119__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000258119__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000258119__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000258119__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000258119__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000258119__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000258119__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Liver Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/liver/patient/child-liver-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/liver/patient/child-liver-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389318]</p><p id="CDR0000258119__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000258119__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000258119__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000258119__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000258119__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65879.5/?report=reader">PubReader</a></li><li><a href="/books/NBK65879.5/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65879" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65879" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Liver Cancer Treatment (PDQ®): Patient Version. 2016 Jun 30. 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class="bk_col_itm"><a href="/books/NBK65879.3/">NBK65879.3</a></span> October 30, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65879.2/">NBK65879.2</a></span> October 1, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65879.1/">NBK65879.1</a></span> August 21, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000258119__1" ref="log$=inpage&link_id=inpage">General Information About Childhood Liver Cancer</a></li><li><a href="#CDR0000258119__26" ref="log$=inpage&link_id=inpage">Stages of Childhood Liver Cancer</a></li><li><a href="#CDR0000258119__48" ref="log$=inpage&link_id=inpage">Recurrent Childhood Liver Cancer</a></li><li><a href="#CDR0000258119__50" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000258119__89" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Liver Cancer</a></li><li><a href="#CDR0000258119__206" ref="log$=inpage&link_id=inpage">To Learn More About Childhood Liver Cancer</a></li><li><a href="#CDR0000258119__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65790/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389380" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Osteosarcoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Osteosarcoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909944" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Carcinoma of Unknown Primary Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Carcinoma of Unknown Primary Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31661207" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Adrenocortical Carcinoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop 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