Liver cancer is very rare in children. If it is found early, it can usually be successfully treated with a combination of chemotherapy followed by surgery in specialist units.

Types of liver cancer in children

This information is mostly about a type of liver cancer called hepatoblastoma.

This is the main type of liver cancer in children. But it is still very rare. In the UK, less than 20 cases are diagnosed each year. It usually affects young children under the age of 4.

What are the other types of liver cancer in children?

Children can sometimes get a type of liver cancer called hepatocellular carcinoma (HCC). This mainly affects older children and teenagers. It’s more common in parts of the world with high hepatitis B levels. It can sometimes affect children with other long term liver disease. For example, inherited conditions.

You can find out more about HCC liver cancer here. 

Some other types of cancer can start in the liver but are not caused by liver cells. These include sarcoma, lymphoma and neuroblastoma.

Cancers that start in another part of the body can also spread to the liver. This is called secondary liver cancer.

Cancer treatment depends on the type of cell where the cancer starts. You can find out more about these other types of cancer on the Macmillan website.

What causes hepatoblastoma?

Hepatoblastoma starts in developing liver cells. Something goes wrong in the cell that means it keeps on making more cells. This causes a tumour in the liver.  For most children we do not know why this happens.

Children with an inherited condition such as familial adenomatous polyposis (FAP) or Beckwith-Wiedemann syndrome may have an increased risk of hepatoblastoma. There is also some evidence that having a low birth weight could increase the risk. However, most children with a low birth weight will not develop hepatoblastoma.

There is no evidence that hepatoblastoma is caused by viral hepatitis. Or by anything the child or their parents have done.

What are the symptoms of hepatoblastoma?

The most common symptom is a swelling or lump in the tummy. This can be painless.

Sometimes, there are other symptoms. These may include:

• Not wanting to eat
• Losing weight
• Feeling very tired and not wanting to move about or do usual activities
• A high temperature (fever)
• Being sick (vomiting)
• A yellow colour to the eyes or skin (jaundice)

Lots of things can cause these symptoms. They usually do not mean that your child has hepatoblastoma. But it is important to see a doctor and get them checked out.

How is hepatoblastoma diagnosed?

Your child’s medical team will do tests to find out what is causing their symptoms. If they think it may be hepatoblastoma they will do more tests to confirm this and to find out:

• how big the tumour is
• where it is
• if the hepatoblastoma has spread to other parts of the liver or other parts of the body

In around 4 out of 5 children diagnosed with hepatoblastoma it has not spread. If it has spread this is usually to the lungs. So, the lungs are always checked as part of the diagnostic tests.

The medical team will look at all the test results together to decide on the diagnosis.

Blood tests

Blood tests can check for lots of possible liver problems. Your child might have a test called an alpha-fetoprotein test (AFP). This test checks for a protein made by hepatoblastoma. You might hear this called a “tumour marker”.

Find out more about blood tests

Imaging tests

Ultrasound scans are quick and painless. They can be used to find out where a tumour is and how big it is.

 CT and MRI scans can look at the whole of your child’s tummy (abdomen) and chest. They can give the medical team more details about the tumour and check if it has spread.

Find out more about imaging tests

Your child will also have blood tests and scans to monitor their condition during and after treatment.

Biopsy

A biopsy is a small surgical procedure. A long needle is used to take a sample from the lump.

This is usually done with a general anaesthetic. So, your child will be asleep during the procedure.

The sample is looked at in a lab. This can help to confirm that the lump has been cause by hepatoblastoma.

In some cases, a biopsy is not possible or safe. Your team might decide to start treatment without a biopsy.

Find out more about liver biopsies

How is hepatoblastoma treated?

Hepatoblastoma is a rare condition. Your child will need to be treated at a specialist centre. This could mean travelling to a hospital further away. They will be looked after by a multidisciplinary team (MDT). This is a group of healthcare professionals with different specialisms who work together to ensure your child gets the right care for them.

The medical team will talk to you about the possible treatment plan for your child. This will depend on the size and location of the tumour and if it has spread.

Treatment is usually a combination of chemotherapy and surgery.

Chemotherapy for hepatoblastoma

Chemotherapy is used to shrink the tumour, treat cancer cells that have spread and reduce the risk of the cancer coming back. It is usually given as injections or as a drip.

Your child will also have more blood tests and scans to check how well the treatment is working.

The type of chemotherapy used will be different for different children. You can ask the medical team:

• How will the chemotherapy be given?
• How often will my child have treatment?
• How long do they need to be in hospital for each treatment?
• How many treatments will they have and for how long?
• What tests will they have to monitor the treatment?
• What side effects could the chemotherapy cause?
• How can we prevent or manage side effects?

Surgery for hepatoblastoma

The aim of surgery is to completely remove the tumour. It is usually done after chemotherapy so that the tumour is smaller. If the tumour is small and easy to get to then surgery might happen first. The surgery will be done by a specialist surgeon.

The liver is very good at repairing itself. So, in most cases, if the whole tumour is removed and 1/3 of the liver is left behind, the liver will regrow quickly and be able to do all its usual jobs.  

If the hepatoblastoma has spread to the lungs this is usually completely cured by chemotherapy before surgery. In some cases, more treatment is needed.  This might be another operation or a procedure called ablation.

Sometimes liver surgery is not possible. For example,

• if chemotherapy does not shrink the tumour
• if the hepatoblastoma has spread to all the different parts of the liver
• or the tumour is in a position close to all the important blood vessels in the liver

 In these situations, your child might be considered for a liver transplant.

You can find out more about liver transplants in children here.

Clinical trials

Your child’s medical team might suggest taking part in a clinical trial. This could be a study to look at a new treatment and compare to the current treatment. These trials have led to big improvements in how children’s cancer is treated today compared to 10-15 years ago.

You do not have to agree to joining a trial. The trial team should talk you through what is involved and the possible risks and benefits. You can also take your child out of a trial at any point.

What is the long-term outlook for children with hepatoblastoma?

We cannot say exactly what will happen to your child. Every case is different.

Many children are treated successfully and grow up well. Some children may have side effects from treatment that only appear years later. So, children have regular check-ups after treatment has ended. This may include blood tests and scans.

Children who have a liver transplant will need to take medicines for the rest of their lives. These supress the immune system to stop the body rejecting the new liver.

Your child’s medical team are the best people to talk to about what the future may hold. They will be able to give you information based on your child’s condition and the treatment they are having.

Liver UK offers support for children and families with any kind of liver condition. Follow this link to find out more.

Our expert reviewers:

We would like to thank everyone who helped with creating and reviewing this page. Including Mr Khalid Sharif, Consultant Paediatric Hepato-biliary and Transplantation Surgeon, Birmingham Children’s Hospital.

Find out how we make our patient information.

Everyone’s experience of liver cancer will be different. Always talk to your specialist medical team for personal advice.