Children's treats all primary liver tumors occurring in children and young adults. The two most common types of liver tumors are hepatoblastoma and hepatocellular carcinoma. We care for both newly diagnosed liver cancer and for children
with relapsed disease.
have some of the most experienced pediatric liver cancer oncologists and
surgeons in the world, as well as internationally recognized pediatric
subspecialists who use sophisticated technology and therapies to maximize
outcomes for our patients.
In addition to a complete physical
examination and medical history, our doctors use a variety of tests to diagnose
liver cancer in children. These tests range from blood laboratories (to assess
organ function and measure proteins excreted by the tumors) to advanced imaging
computerized tomography, and magnetic resonance imaging). Ultimately, the
diagnosis is confirmed by tumor biopsy.
Obtaining a correct diagnosis is a crucial first step in making sure
your child receives the most appropriate treatment. Because liver pathology is
complicated, liver tumors are sometimes misdiagnosed. For instance, hepatocellular
carcinoma may be misdiagnosed as hepatoblastoma. Dana-Farber/Boston Children's has one of the
largest, most sophisticated pathology services of its kind in the country. Our
board-certified pediatric pathologists have further specialization in a variety
of forms of cancer, with particular expertise in rare pediatric tumors.
Children with hepatoblastoma or
hepatocellular carcinoma will require surgery to remove the tumor. This may
involve partial removal of the liver or, in rare cases, a total hepatectomy
(removal of the liver) and liver transplant (in
which your child's liver is replaced with a liver from a donor). If surgery is
deemed too risky or is likely to leave part of the tumor behind, the child may
be treated initially with chemotherapy to shrink the tumor to make it easier to remove. Hepatoblastoma is remarkably responsive to chemotherapy, and the majority of patients receive it in addition to surgery (usually both before and after surgery). Hepatocellular
carcinoma is less responsive to chemotherapy, therefore surgery is key.
Surgery may be more difficult for patients
with hepatocellular carcinoma as this type of cancer often
metastasizes, can involve multiple parts of the liver, and can occur in
patients with underlying liver disease. Doctors may also perform a procedure
called chemoembolization or radioembolization of the hepatic artery, which can
allow direct delivery of therapy via the main blood vessel in the liver to the
sites of disease.
Any tumor in the upper gastrointestinal tract,
including the liver, is a very complicated surgery and requires very specialized
expertise. However, because liver tumors in children are so rare, very few pediatric
surgeons have extensive experience in treating these tumors.
Dana-Farber/Boston Children’s, we have surgeons who specialize in pediatric
liver surgery and have successfully performed some of the most complicated liver
and upper gastrointestinal surgeries in children. Our
surgeons utilize the full range of surgical options for liver tumors, including
total hepatectomy with “back table” resection of the tumor and
autotransplantation of the remnant liver, resections requiring reconstruction
of the blood vessels or bile ducts or resections requiring heart-lung
bypass to remove a tumor that has grown into the heart. When none of these options are sufficient,
liver transplantation is an option and in the most extreme cases, a full
multivisceral transplant may be needed to replace multiple organs that are
involved by the tumor.
patients have access to the broadest set of pediatric and oncologic expertise
available. The breadth of our expertise allows us to assemble a team of
specialists to meet the specific needs of each patient.
At the core of the treatment team are
medical oncologists who specialize in treating liver cancer. Many of our
physicians are also active researchers, so our patients have access to the very
best and up-to-date treatments available.
From there, we build a
team that is best suited to carry out the patient’s treatment plan, including surgeons,
hepatologists (liver specialists), radiation oncologists, interventional
radiologists, pathologists, and transplant physicians. One of our
surgeons, Heung Bae Kim, MD, is one of only a few surgeons in the nation
who are dual-trained in pediatric general surgery and in liver transplantation –
which means he brings to your child a virtually unparalleled expertise in
pediatric liver tumor surgery.
We round out our treatment team
with experts who help your child prepare for life during and after treatment,
including psychiatrists and psychologists, child life specialists, social
workers, nutritionists, and school specialists.
clinical research program offers unique access to clinical
trials in which children can receive the newest liver
cancer treatments. A major focus of our research program is the rapid
translation of scientific discoveries from the laboratory to the bedside to
benefit patients. Through this research, our physicians work to improve
therapeutic approaches and outcomes for hard-to-treat tumors. We are also
investigating biologic therapies that use the body’s own immune system to fight
cancer, new ways to deliver chemotherapy, and new interventional radiology
techniques to enhance care.
Precision Medicine for Liver Tumors: One or our surgeon-scientists,
Khashayar Vakili, MD, is looking for a mechanism to decrease the growth of hepatocellular carcinoma. Transplant
and surgery alone are usually ineffective for hepatocellular carcinoma because
of the aggressive nature of the disease and the fact that there is no
chemotherapy that actually works against the tumor. By studying individual
patient tumors, he hopes to gain a greater understanding of the tumor’s biology
with the goal of finding new therapeutic targets that can directly impact the
specific tumor mutation – a type of treatment often referred to as precision
Manuel's family journeyed from Mexico to Boston to find the best treatment for Manuel's liver tumor.
Rated the top pediatriccancer center by U.S. News & World Report