Liver Tumors

The liver is the body’s largest solid organ. Lying next to the stomach on the right side of the abdomen, it has many jobs — like cleansing the blood of toxins, producing bile (which helps break down food during digestion), and storing energy in the form of a sugar called glycogen.

Tumors happen when abnormal cells form a mass or growth. If a tumor develops in the liver, the liver can’t work as it should.

Types of Tumors

Tumors can be benign (not cancerous) or malignant (cancerous).

Most benign liver tumors are present at birth. They’re usually the result of abnormal tissue growth while the fetus was developing. Types of benign liver tumors include mesenchymal hamartomas, adenomas, and hemangiomas. These tumors can be watched by a doctor or removed through surgery with no other treatment needed.

Malignant liver tumors happen less frequently. These usually require more aggressive treatment, like chemotherapy and surgery.

Malignant (Cancerous) Tumors

Hepatoblastoma is most common in very young children (usually younger than 3). When found early, this type of cancer typically responds well to treatment with chemotherapy and surgery.

Hepatocellular carcinoma is more common in adults but can affect older children. Because it can be hard to remove surgically and might not respond to chemotherapy, hepatocellular carcinoma can be difficult to treat.

The cause of malignant liver tumors is unknown. But risk factors for hepatoblastoma include Beckwith-Wiedemann syndrome (a disorder that can cause too much growth in the body, including in the internal organs), familial adenomatous polyposis (a condition that causes polyps to form in the large intestine), being male, and having a very low birth weight.

Medical conditions connected with an increased risk of hepatocellular carcinoma include infection with hepatitis B or C, or conditions connected with cirrhosis (long-term damage) of the liver, like hereditary hemochromatosis and autoimmune hepatitis.

Symptoms

Early on, a child with a liver tumor might have few symptoms — or none at all. As the mass grows, however, these symptoms may develop:

• a lump that can be felt in the abdomen, or a swollen abdomen
• pain on the right side of the abdomen, where the liver is (if the tumor is pressing on nerves or muscles, pain may extend upward and back)
• early puberty
• decreased appetite and weight loss
• vomiting
• jaundice (yellowing of the eyes and skin)

Diagnosis

A doctor who thinks a child might have a liver tumor will do a thorough physical exam and order these tests:

• Imaging studies. Imaging studies can include an ultrasound, CT scan, or MRI. These tests can help find the size and location of the tumor and also help show if cancer has spread (metastasized) to other parts of the body.
• Biopsy. A biopsy is when a piece of tissue is removed from the body for study in a lab. This closer look helps doctors make a diagnosis (such as cancer) and choose the right treatment.
• Blood tests. Tests such as a complete blood count, liver function panel, and blood chemistries can show how well the liver and other organs are working. If the doctor thinks the tumor is related to a genetic condition, certain genetic tests might be done, too.

Treatment

Treatment of malignant liver tumors depends on staging. Staging is a way to classify the extent of the disease. It takes into account the size of the tumor (or tumors), how easily the tumor can be removed by surgery, and whether the tumor has spread to nearby or distant organs.

This information, in addition to a child’s age and overall heath, helps doctors develop a treatment plan. The plan might include the following options, in combination or alone:

• Surgery. Benign masses are usually removed. Malignant tumors also may require surgery to remove as many of the cancerous cells as possible. The amazing thing about the liver is that even if a large portion is removed, the remaining part usually can regenerate (“re-grow”). The liver is the only organ that can grow back in this way.
• Chemotherapy. Chemotherapy works to treat cancer throughout the body. Often, chemo drugs are combined to attack the cancer cells in different ways, which is effective in diseases such as hepatoblastoma. Side effects can happen, but will ease once treatment ends.
• Radiation therapy. Radiation therapy uses high-energy radiation to target and destroy cancer cells in a specific area. It’s not a common treatment for hepatoblastoma.
• Liver transplant. If a tumor can’t be removed without a loss of liver function, a liver transplant may be necessary. Many kids who have liver transplants go on to live normal, healthy lives. They’ll need to take medicine to help prevent complications and have regular checkups to make sure the liver is working correctly.

Coping

The stress of having a child who is being treated for a tumor can be overwhelming for any parent. Talk with your child’s medical team, who can answer any questions and will support you during this challenging time.