Treatment of Childhood Liver Cancer

What is childhood liver cancer? 

It is when malignant cells start forming in the tissues of the liver. It is mostly determined by the symptoms like abdominal pain or a lump in the abdomen, swelling in the abdominal region, nausea, vomiting, and loss of appetite.

There are certain diseases, which act as risk factors for childhood liver cancer. They are: 

1. Aicardi Syndrome 
2. Glycogen storage disease 
3. Trisomy 18
4. Hemi hyperplasia

A CT scan, serum tumor marker test, or a complete blood count test can diagnose the condition. Other than that, abdominal X-ray, MRI, and biopsy are also helpful in this case.

Standard treatment procedures for Childhood Liver Cancer- 

1. Surgery 

Partial hepatectomy, liver transplant, or resections of metastases are the commonly approached options. Surgery is applicable in both advanced and primary cases. A number of tests are carried out before surgery to figure out the size of the primary tumor, the level of alpha-fetoprotein in blood, or whether there's more than one tumor. If the patient is eligible for a transplant, he/she will have to wait for an organ donor that matches the requirements. In some cases, chemotherapy is given before surgery to shrink the tumor. Surgical procedures have their own drawbacks, like the chance of infection, pain, or bleeding. However, doctors will calculate the risk factors and then go for it so that the patient's life is not put at high risk.

2. Watchful Observation 

It is also quite useful because there are changes in symptoms disappearing or changing at times. Doctors monitor the health of the patients carefully for a significant period before taking any action. It is also used for Hepatoblastoma, where the tumor has already been removed by surgery.

3. Chemotherapy

It is one of the most commonly prescribed treatment options that use drugs to kill cancer cells or stop their growth within the body. Drugs are either administered orally or intravenously into the bloodstream. Sometimes, combination chemotherapy also opts for better results (use of more than one anti-cancer drug at the same time)

There are multiple chemo drugs that are effective for childhood liver cancer. Some of them are stated as follows: 

1. Gemcitabine- Categorized as an ant metabolite, Gemcitabine is a cytotoxic chemotherapy drug that is either prescribed alone or with Docetaxel for better impact.
2. Oxaliplatin- For Hepatoblastoma, Oxaliplatin is given in combination with other anti-cancer drugs like Cisplatin and Vincristine. This platinum-based medication is given as an injection into the vein twice every 14 days.
3. Cisplatin- It is an antineoplastic cytotoxic chemotherapy drug that is classified as an alkylating agent. Being the most common platinum-based chemotherapy medicine, Cisplatin 50 mg has shown remarkable effects on the case of childhood liver cancer.
4. 5 Fluorouracil- This chemotherapy drug is also an antimetabolite that is available in the market as Fluorouracil cream and injection. While the cream or topical is used for treating skin cancer and similar conditions, in the case of childhood liver cancer, it is given as an injection.
5. Capecitabine- When administered in the body, Capecitabine gets converted to Fluorouracil to target the cancer cells and prevent them from forming new DNA. This is how Capecitabine 500 mg is helpful for destroying liver cancer cells in the body.

Chemotherapy has certain side effects like:

• Nausea and vomiting
• Hair loss 
• Mouth sores
• Loss of appetite 
• Fatigue 
• Diarrhea 
• Increased chances of infections
• Easily bruising and bleeding

4. Radiation Therapy 

There are two types of radiation therapy that are used for treating childhood liver cancer: External radiation therapy and internal radiation therapy. They are the use of high-energy X-rays or radioactive needles to destroy the cancer cells. The former is used to treat Hepatoblastoma that can't be dealt with surgical procedures. It is also used for relieving the symptoms at times.

The side effects of radiation therapy are: 

• skin color change in areas where the radiation beam is given 
• blistering and peeling of skin 
• loss of appetite
• diarrhea 
• nausea and vomiting

5. Ablation 

It is a process by which affected tissues are removed and destroyed. It's divided into two categories- radiofrequency ablation and percutaneous ethanol injection. Both are useful for treating recurrent Hepatoblastoma. Although serious complications are not seen in this treatment procedure, fever, liver infection, and abdominal pain have been noticed in some cases.

6. Targeted therapy

It is a new type of drug treatment that targets the cancer cells in the body to destroy them. It can aim at specific abnormalities or simply target the blood vessels to slow down the growth of malignant cells.

Certain important targeted therapy drugs are: 

1. Lenvatinib- Lenvima or Lenvatinib is first-line therapy for childhood liver cancer. It is administered orally that acts upon the cancer cells with its anti-angiogenic activities. Lenvatinib 4mg and Lenvatinib 10 mg target the blood vessels to destroy the cancer cells.
2. Sorafenib- Sorafenib 200 mg is a kinase inhibitor. It simply works by blocking the effect of abnormal proteins on the cancer cells or destroy them.
3. Regorafenib- This multikinase inhibitor is specifically known to target the VEGFR-TIE2 tyrosine kinase to stop the growth of cancer cells. The normal dosage is 160mg - four Regorafenib 40 mg tablets per day.

The common side effects of targeted therapy are diarrhea and constipation, shortness of breath, fatigue, dryness of skin, and cold-like symptoms. However, these aren't persistent and go away easily.

7. Immunotherapy

Here, the immune system of the patient is given a boost by the use of drugs like Atezolizumab to fight the cancer cells from within. 

Atezolizumab 60mg is a PD-L1 inhibitor that is used commonly for conducting immunotherapy in patients. It's given intravenously once at an interval of 2, 3, 4 weeks, depending on the condition.

Conclusion

Liver cancer cases that are connected to the Hepatitis B virus-like Hepatocellular Carcinoma can be approached with antiviral drugs. In some cases, patients also participate in a clinical trial. With the advancement of medical science, newer and better treatment methods are coming to the surface to cure childhood liver cancer with lesser side effects.