August 30,2019

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Things You Should Be Aware Of Pediatric Liver Cancer

A study by Lancet Oncology journal has shown that there are almost 4,00,000 new cases of childhood cancer annually across the world. This figure is alarming as barely half the number of children mentioned above are logged in national health registries. One such childhood cancer which is not so known to the masses is pediatric liver cancer. Even though there are only 100-150 annual cases of pediatric liver cancer, the effect it has on children is ravaging.

What Exactly Is Pediatric Liver Cancer?

Pediatric liver cancer is a disease in which malignant tumour or cancerous cells start forming in the tissues of the child’s liver. When the malignant tumour is in the liver, it is known as primary cancer. When it starts spreading to other parts of the body, it is known as secondary liver cancer.

Types Of Liver Cancer In Children

Pediatric liver cancer is generally of two types. Hepatoblastoma and Hepatocellular Carcinoma. Both of these together account for 1-2% of cancer in children worldwide.

1) Hepatoblastoma

Hepatoblastoma is one of the most common liver cancer in children that do not spread outside the liver. It occurs in children between the ages of 2 months and 3 years. Most Hepatoblastoma tumours begin from the right lobe of the liver.

Causes of Hepatoblastoma

It is vital to note that infants born with a lower birth weight are at higher risk of getting Hepatoblastoma. Some of the other main causes of Hepatoblastoma are:

1) Beckwith-Wiedemann Syndrome: It is an overgrowth syndrome, that affects many parts of the body. It is characterized by the combination of Wilm’s tumour, genitourinary malformations, kidney failure and gonad (testes and ovaries) abnormalities.

2) Hemihypertrophy: Hemihypertrophy is another growth disorder where there is an asymmetry in the growth of limbs of children.

3) Familial adenomatous polyposis: It is a group of rare inherited diseases occurring in the gastrointestinal tract.

Children who are exposed to Hepatitis B viral infection and Biliary Atresia are also at a higher risk of Hepatoblastoma.

2) Hepatocellular Carcinoma

Hepatocellular Carcinoma is a pediatric liver cancer that spreads to other parts of the body. It is seen in children above 14 years of age. The incidence of Hepatocellular Carcinoma is highest in Asia and Africa as these are the regions having most patients with liver disorders.

Causes of Hepatocellular Carcinoma

Hepatocellular Carcinoma is most commonly seen in adults having Hepatitis B or Hepatitis C infection. Some other prominent causes of Hepatocellular Carcinoma are:

• Exposure to toxic chemicals
• Inborn and acquired metabolic disease
• Autoimmune Diabetes
• Obesity

Symptoms of Pediatric Liver Cancer

The symptoms become more evident once the tumour has become large. A doctor should be consulted immediately once the following symptoms occur:

• Lump or swelling in the abdomen
• Sudden weight loss
• Poor appetite
• Precocious(early) puberty in boys
• Nausea and vomiting

Treatment of Pediatric Liver Cancer

Before learning about the treatment options of pediatric liver cancer, one should know the chances of recovery. The chances of recovery (prognosis) during the treatment of liver cancer depend on a wide range of factors. They are:

• Stage of the cancer
• Whether cancer can be fully removed by surgery
• Type of Liver Cancer
• Whether cancer has been diagnosed or returned

Prognosis can also depend on:

• Certain characteristics of the cancer cell (how it looks under a microscope)
• Whether the Alpha-Fetoprotein Level (AFP- a plasma protein produced by the embryonic yolk sac and the fetal liver) blood levels take a tip after beginning chemotherapy

Treatment Methods

There are five primary methods used to treat pediatric liver cancer.

1) Surgery

Surgery is done, whenever possible, to completely remove the cancerous cells. The types of surgery done in pediatric liver cancer treatment are:

Cryosurgery: In cryosurgery, specific instruments are used to destroy abnormal tissue, like carcinoma in situ (a group of abnormal cells that have not spread from the location where they first formed, although carrying the potential to do so). This treatment is known as cryotherapy.

Partial Hepatectomy: Also known as liver resection, partial hepatectomy involves the removal of cancerous cells from the affected part of the liver. The part removed maybe a wedge of tissue, an entire lobe or a large part of the liver.

Total Hepatectomy and Liver Transplant: In this surgical procedure, the entire liver is removed to replace it with a healthy liver from a donor. A liver transplant treatment is possible when the cancerous cells have not spread beyond the liver and a donated liver can be acquired.

Resection of Metastases: In this type of surgery, the cancerous cells that have spread outside of the liver are removed.

2) Watchful Waiting

Also called wait and watch, it is an approach to a medical problem where time is allowed to pass before medical intervention is used. It is to look out for any variation in the symptoms.

3) Chemotherapy

Chemotherapy is a medical procedure that involves the use of drugs to inhibit the growth of cancerous cells in the body. This treatment either kills the cancerous cells or stops them from dividing further.

4) Radiation Therapy

In radiation therapy, high-energy x-rays or other types of radiation are used to destroy cancer cells or to prevent them from growing.

5) Percutaneous Ethanol Injection

In this treatment, ethanol is injected with the help of a small needle, directly into the tumour cells to kill it.

Challenges Involved In The Liver Cancer Treatment In India 

There are various hurdles faced by the families of children requiring cancer treatment in the country:

First, the diagnosis and treatment of live cancer need to be made accessible to all parts of the country. Right now, in India, hospitals performing pediatric liver transplant are clustered around big cities. The patients living in villages and remote areas need to travel long distance for availing the treatment. It is a critical factor as time plays a huge role in cancer treatment.

Second, liver cancer treatment involves more than equipment. The child patient should be given physical, mental as well as emotional support throughout the treatment. Efforts should be made to keep the child in a positive frame of mind.

Third, after successful treatment, the health of the child has to be monitored closely. It can include regular check-ups and nutritional support. The absence of it often causes relapses in the children, which makes the post-care extremely crucial.

How The Pravin Agarwal Foundation Helps To Combat These Challenges 

The Pravin Agarwal Foundation (TPAF) is a humanitarian organization in India that is devoted to making pediatric liver transplants in India accessible as well as affordable. The foundation has collaborated with famous NGO’S for liver transplant in the country like Milaap, National Liver Foundation, Jeet Foundation etc. which effectively removes the bottlenecks in the surgery. TPAF has also partnered with top healthcare centres in India for giving the patients high-quality medical treatment and post-treatment care.

Summary

The liver is one of the vital organs in the body having a role in almost all of the bodily function. It is important to note that pediatric liver cancer starts with a tumour in the liver and therefore, can be effectively prevented once necessary action is taken. This blog will help parents to have the upper hand in protecting their children from pediatric liver cancer.

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You can also Join Our TPAF Facebook Group – The Pravin Agarwal Foundation (TPAF) Support group, created to form a network of families/caregivers of children who suffer from Liver Disease. We would request to join the platform to share experiences & concerns, provide emotional & social support and encourage one another in this journey.