Question:  What are the treatments for Childhood Liver Cancer ?
Answer: Key Points
                    - There are different types of treatment for patients with childhood liver cancer.    - Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.    - Some cancer treatments cause side effects months or years after treatment has ended.     - Six types of standard treatment are used:         - Surgery     - Watchful waiting     - Chemotherapy     - Radiation therapy     - Ablation therapy     - Antiviral treatment        - New types of treatment are being tested in clinical trials.         - Targeted therapy        - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.
                
                
                    There are different types of treatment for patients with childhood liver cancer.
                    Different types of treatments are available for children with liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.   Taking part in a clinical trial should be considered for all children with liver cancer. Some clinical trials are open only to patients who have not started treatment.
                
                
                    Children with liver cancer should have their treatment planned by a team of healthcare providers who are experts in treating this rare childhood cancer.
                    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with liver cancer and who specialize in certain areas of medicine. It is especially important to have a pediatric surgeon with experience in liver surgery who can send patients to a liver transplant program if needed. Other specialists may include the following:         -  Pediatrician.    -  Radiation oncologist.    -  Pediatric nurse specialist.    -  Rehabilitation specialist.    -  Psychologist.    -  Social worker.
                
                
                    Some cancer treatments cause side effects months or years after treatment has ended.
                    Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:          - Physical problems.     - Changes in mood, feelings, thinking, learning, or memory.     -  Second cancers (new types of cancer).        Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
                
                
                    Six types of standard treatment are used:
                    Surgery    When possible, the cancer is removed by surgery.            - Partial hepatectomy: Removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with a small amount of normal tissue around it.      - Total hepatectomy and liver transplant: Removal of the entire liver followed by a transplant of a healthy liver from a donor. A liver transplant may be possible when cancer has not spread beyond the liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.      -  Resection of metastases: Surgery to remove cancer that has spread outside of the liver, such as to nearby tissues, the lungs, or the brain.            Factors that affect the type of surgery used include the following:            - The PRETEXT group and POSTTEXT group.     - The size of the primary tumor.     - Whether there is more than one tumor in the liver.     - Whether the cancer has spread to nearby large blood vessels.     - The level of alpha-fetoprotein (AFP) in the blood.     - Whether the tumor can be shrunk by chemotherapy so that it can be removed by surgery.     - Whether a liver transplant is needed.           Chemotherapy is sometimes given before surgery, to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy.    Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.       Watchful waiting     Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. In hepatoblastoma, this treatment is only used for small tumors that have been completely removed by surgery.       Chemotherapy    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Treatment using more than one anticancer drug is called combination chemotherapy.      Chemoembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of regional chemotherapy used to treat childhood liver cancer. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine. This procedure is also called transarterial chemoembolization or TACE.    The way the chemotherapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group.        Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:            -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group. Radioembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of internal radiation therapy used to treat hepatocellular carcinoma. A very small amount of a radioactive substance is attached to tiny beads that are injected into the hepatic artery through a catheter (thin tube). The beads are mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the radiation is trapped near the tumor to kill the cancer cells. This is done to relieve symptoms and improve quality of life for children with hepatocellular carcinoma. External radiation therapy is used to treat hepatoblastoma that cannot be removed by surgery or has spread to other parts of the body.       Ablation therapy     Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer:             -  Radiofrequency ablation: The use of special needles that are inserted directly through the skin or through an incision in the abdomen to reach the tumor. High-energy radio waves heat the needles and tumor which kills cancer cells. Radiofrequency ablation is being used to treat recurrent hepatoblastoma.     -  Percutaneous ethanol injection: A small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed. Percutaneous ethanol injection is being used to treat recurrent hepatoblastoma.              Antiviral treatment    Hepatocellular carcinoma that is linked to the hepatitis B virus may be treated with antiviral drugs.
                
                
                    New types of treatment are being tested in clinical trials.
                    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.     Targeted therapy     Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Targeted therapy is being studied for the treatment of undifferentiated embryonal sarcoma of the liver and liver cancer that has come back.
                
                
                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
                
                
                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
                
                
                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the treatment group may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
                
		        
		            Treatment Options for Childhood Liver Cancer
		            
		                
		                    Hepatoblastoma
		                    Treatment options for hepatoblastoma that can be removed by surgery at the time of diagnosis may include the following:         -  Surgery to remove the tumor, followed by watchful waiting or chemotherapy, for hepatoblastoma with pure fetal histology.    - Surgery to remove the tumor, with combination chemotherapy given either before surgery, after surgery, or both, for hepatoblastoma that is not pure fetal histology. For hepatoblastoma with small cell undifferentiated histology, aggressive chemotherapy is given.        Treatment options for hepatoblastoma that cannot be removed by surgery or is not removed at the time of diagnosis may include the following:         - Combination chemotherapy to shrink the tumor, followed by surgery to remove the tumor.    - Combination chemotherapy followed by a liver transplant.    -  Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove the tumor.        For hepatoblastoma that has spread to other parts of the body at the time of diagnosis, combination chemotherapy is given to shrink the cancer in the liver and cancer that has spread to other parts of the body. After chemotherapy, imaging tests are done to check whether the cancer can be removed by surgery.    Treatment options may include the following:         - If the cancer in the liver and other parts of the body can be removed, surgery will be done to remove the tumors followed by chemotherapy to kill any cancer cells that may remain.    - If the cancer in the liver cannot be removed by surgery but there are no signs of cancer in other parts of the body, the treatment may be a liver transplant.     - If the cancer in other parts of the body cannot be removed or a liver transplant is not possible, chemotherapy, chemoembolization of the hepatic artery, or radiation therapy may be given.        Treatment options in clinical trials for newly diagnosed hepatoblastoma include:         - A clinical trial of new treatment regimens based on how likely it is the cancer will recur after initial treatment.
		                
		                
		                    Hepatocellular Carcinoma
		                    Treatment options for hepatocellular carcinoma that can be removed by surgery at the time of diagnosis may include the following:         - Surgery alone to remove the tumor.    -  Surgery to remove the tumor, followed by chemotherapy.    -  Combination chemotherapy followed by surgery to remove the tumor.        Treatment options for hepatocellular carcinoma that cannot be removed by surgery at the time of diagnosis may include the following:         - Chemotherapy to shrink the tumor, followed by surgery to completely remove the tumor.    - Chemotherapy to shrink the tumor. If surgery to completely remove the tumor is not possible, further treatment may include the following:               -  Liver transplant.      - Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove as much of the tumor as possible or liver transplant.      - Chemoembolization of the hepatic artery alone.             -  Radioembolization of the hepatic artery as palliative therapy to relieve symptoms and improve the quality of life.        Treatment for hepatocellular carcinoma that has spread to other parts of the body at the time of diagnosis may include:         - Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible from the liver and other places where cancer has spread. Studies have not shown that this treatment works well but some patients may have some benefit.        Treatment options for hepatocellular carcinoma related to hepatitis B virus (HBV) infection include:         - Surgery to remove the tumor.    -  Antiviral drugs that treat infection caused by the hepatitis B virus.
		                
		                
		                    Undifferentiated Embryonal Sarcoma of the Liver
		                    Treatment options for undifferentiated embryonal sarcoma of the liver (UESL) may include the following:         -  Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible. Chemotherapy may also be given after surgery to remove the tumor.    - Surgery to remove the tumor followed by chemotherapy. A second surgery may be done to remove tumor that remains, followed by more chemotherapy.    -  Liver transplant if surgery to remove the tumor is not possible.    - A clinical trial of a combination of targeted therapy, chemotherapy and/or radiation therapy before surgery.
		                
		                
		                    Infantile Choriocarcinoma of the Liver
		                    Treatment options for choriocarcinoma of the liver in infants may include the following:          -  Combination chemotherapy to shrink the tumor, followed by surgery to remove the tumor.    - Surgery to remove the tumor.
		                
		                
		                    Recurrent Childhood Liver Cancer
		                    Treatment of recurrent hepatoblastoma may include the following:         -  Surgery to remove isolated (single and separate) metastatic tumors with or without chemotherapy.    -  Combination chemotherapy.    -  Liver transplant.    -  Ablation therapy (radiofrequency ablation or percutaneous ethanol injection).    - A clinical trial of a new treatment.        Treatment of progressive or recurrent hepatocellular carcinoma may include the following:         -  Chemoembolization of the hepatic artery to shrink the tumor before liver transplant.    - Liver transplant.    - A clinical trial of a new treatment.
		                
		                
		                    Treatment Options in Clinical Trials
		                    Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood liver cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.