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儿童肝癌治疗(PDQ®)

儿童肝癌概况

儿童肝癌是一种在肝脏组织中形成恶性（癌）细胞的疾病。

肝脏是人体最大的器官之一。可分为四叶，位于胸腔内腹部右上方。肝脏的三个重要功能是：

  • 过滤血液中的有害物质，并通过粪便和尿液将其排出体外。
  • 分泌胆汁，促进人体对食物中脂肪的消化。
  • 储存糖原（糖），糖原可为人体提供能量。
    • 肝脏解剖。肝脏位于上腹部，靠近胃、肠、胆囊和胰腺。肝脏有一个右叶和一个左叶。每个叶分成两部分（未显示）。

    肝癌在儿童和青少年中很罕见。

    有不同类型的儿童肝癌。

    儿童肝癌主要有两种类型：

  • 肝母细胞瘤：肝母细胞瘤是最常见的儿童肝癌类型。通常影响3岁以下的儿童。

    • 在肝母细胞瘤中，组织学（癌细胞在显微镜下的外观）影响癌症的治疗方式。肝母细胞瘤的组织学可能是下列之一：

  • 高分化胎儿（纯胎儿）组织学
  • 小细胞未分化组织学
  • 非高度分化的胎儿组织学，非小细胞未分化的组织学
  • 肝细胞癌：肝细胞癌通常会影响年龄较大的儿童和青少年。 与美国相比，在乙型肝炎感染率高的亚洲地区，其更为常见。

    • 其他较不常见的儿童肝癌类型包括：

  • 肝脏未分化胚胎性肉瘤：这种类型的肝癌通常发生在5到10岁的儿童身上。通常遍布肝脏和/或肺部。
  • 婴儿肝绒毛膜癌：这是一种非常罕见的肿瘤，始于胎盘并扩散至胎儿。肿瘤通常在生命的最初几个月内发现。另外，孩子的母亲可能被诊断患有绒毛膜癌。绒毛膜癌是一种妊娠滋养细胞疾病。有关儿童母亲绒毛膜癌治疗的更多信息，请参阅关于妊娠滋养细胞疾病治疗的PDQ摘要。
  • 血管性肝肿瘤：这些肿瘤形成于肝脏内，由形成血管或淋巴管的细胞构成。血管性肝癌可以是良性的（不是癌症）或恶性的（癌症）。有关血管性肝肿瘤的更多信息，请参阅关于儿童血管性肿瘤治疗的PDQ摘要。

    • 该摘要是关于原发性肝癌（始于肝脏的癌症）的治疗。转移性肝癌的治疗，即从身体其他部位开始并扩散到肝脏的癌症，在该摘要中未作讨论。

    成人和儿童均可能发生原发性肝癌。但是，儿童治疗与成人治疗不同。有关成人治疗的更多信息，请参阅关于成人原发性肝癌治疗的PDQ摘要。

    某些疾病和情况会增加儿童患肝癌的危险。

    任何会增加患病几率的因素都称为危险因素。有危险因素并不是说一定会得癌症；没有危险因素也不代表一定不会得癌症。如果认为孩子有患病危险，请咨询医生。

    肝母细胞瘤的危险因素包括以下综合征或情况：

  • 艾卡尔迪综合症
  • 伯-韦综合征
  • 半侧颅面肥大增生
  • 家族性腺瘤性息肉病 (FAP)
  • 糖原贮积病
  • 出生时体重很轻
  • 度生长综合症
  • 某些遗传变化，如18-三体综合征

    • 有肝母细胞瘤风险的儿童可以在出现任何症状之前进行检测，以检查是否患有癌症。每3个月进行一次腹部超声检查直到孩子4岁，并检查血液中的甲胎蛋白浓度。

    肝细胞癌的危险因素包括以下综合征或情况：

  • 阿拉吉欧综合症
  • 糖原贮积病
  • 出生时从母亲传给孩子的乙型肝炎病毒感染。
  • 进行性家族性肝内疾病
  • 酪氨酸血症

    • 一些酪氨酸血症患者会在出现癌症症状或体征之前接受肝移植治疗。

    儿童肝癌的体征和症状包括腹部肿块或疼痛。

    病人在肿瘤增大后会更常出现相关体征和症状。其他疾病也可能引起相同体征和症状。如果孩子有如下症状，请与医生联系: 

  • 腹部出现肿块，可能伴有疼痛。
  • 腹部肿胀
  • 不明原因的体重下降。
  • 食欲不振
  • 恶心呕吐。

    • 用于检查肝脏和血液的检测可用来查明（发现）并诊断儿童肝癌，并确定癌症是否已经扩散。

    可能涉及到以下检查和流程：

  • 体检和病史：对身体进行的检查，以检查身体的一般健康迹象，包括疾病迹象检查，如肿块或任何看似异常的东西。同时还需参考患者的健康习惯、既往疾病及治疗史。
  • 血清肿瘤标记物检测：一种检查血样中体内器官、组织或肿瘤细胞分泌物浓度的方法。血液中某些物质含量升高，与特定类型的癌症相关。这些被称为肿瘤标志物。患有肝癌的儿童的血液中可能含有称为β-人绒毛膜促性腺激素(beta-hCG)的激素或称为α-甲胎蛋白(AFP)的蛋白质。其他癌症、良性肝肿瘤和某些非癌性疾病，包括肝硬化和肝炎，也会增加AFP水平。
  • 全血细胞计数 (CBC)：抽取血液样本并检查以下各项的方法：
  • 红细胞、白细胞和血小板的数量。
  • 红细胞中血红蛋白（携带氧气的蛋白质）的数量。
  • 血液样本中由红细胞组成的部分
  • 肝功能检测：检查血样中肝脏分泌物质含量的方法。若高于正常水平，则肝脏可能出现损伤或癌症。
  • 血液化学核查：一种检查血样中器官和组织所释放某些物质（如胆红素或乳酸脱氢酶(LDH)）含量的方法。某种物质含量异常（高于或低于正常值）可能是疾病的征兆。
  • Epstein-Barr病毒 (EBV)检测：检查血样中EBV抗体和EBV DNA标志物（可在感染EBV的患者血液中检测到）的一种血液检测。
  • 肝炎检测：一种检查血样中是否有肝炎病毒的方法。
  • 利用钆的MRI（核磁共振成像）：一种利用磁铁、无线电波和计算机对肝脏内部区域进行一系列详细成像的方法。一种叫做钆的物质被注入静脉。钆会聚集在癌细胞周围，提亮光片中的显示。这一方法也被称为核磁共振成像(NMRI)。
    • 腹部磁共振成像(MRI)。孩子平躺在一张工作台上，滑进核磁共振扫描仪，拍下身体内部的光片。孩子腹部的垫子可以使光片更清晰。
  • CT扫描（CAT扫描）：通过将电脑与X射线机连接从不同角度拍摄人体内部区域一系列详细图像的方法。可能需将染料注射至静脉或进行吞服，以提高器官或组织显示的清晰度，也称作计算机体层摄影术、计算机断层扫描、或计算机化轴向层面X射线摄影法。在儿童肝癌的诊断中，通常需要对胸部和腹部进行CT扫描。
    • 腹部的计算机断层(CT) 扫描。孩子躺在一张工作台上，滑入CT扫描仪，可以拍摄腹腔内部的X光片。
  • 超声检查：一种将高能声波（超声波）从内部组织或器官反射并产生回声的检查方法。这些回声会形成一种称为超声图的人体组织图像。此类图像可以打印出来用于以后的检查。在儿童肝癌中，通常会对腹部进行超声检查以检查大血管情况。
    • 腹部超声。一个连接到计算机的超声换能器被压在腹部皮肤上。换能器将声波从内部器官和组织反射出去，产生回声，形成声像图（计算机图像）。
  • 腹部X光：进行腹部器官的X光检查。X光是一种能量射线，能穿透身体显示在胶片上生成体内图像。
  • 活组织检查：取出细胞或组织样本，以便在显微镜下观察，以检查是否有癌症的迹象。样本可在手术中取出或观察肿瘤。病理学家在显微镜下观察样本，以找出肝癌的类型。

    • 可以对取出的组织样本进行以下检测：

  • 免疫组织化学：用抗体检查病人组织样本中某些抗原（标记物）的实验室检测。抗体通常与酶或荧光染料相连。抗体与组织样本中的特定抗原结合后，酶或染料被激活，然后在显微镜下可以看到抗原。此类检测用于检查某种基因突变，帮助诊断癌症，并帮助区分不同种癌症。

    • 一些因素会影响预后（恢复机会）和治疗方案的选择。

    肝母细胞瘤的预后（恢复机会）和治疗方案取决于以下因素：

  • PRETEXT 组
  • 肿瘤的大小
  • 肝母细胞瘤的类型是高分化胎儿（纯胎儿）还是小细胞未分化组织学。
  • 癌症是否已经扩散到身体的其他部位，如横膈膜、肺或某些大血管。
  • 肝脏是否存在不止一处肿瘤。
  • 肿瘤周围的覆层是否破裂。
  • 癌症对化疗的反应
  • 肿瘤是否能通过手术完全切除。
  • 患者是否可以进行肝移植。
  • 治疗后甲胎蛋白血浓度是否下降。
  • 孩子的年龄
  • 癌症是刚刚被确诊断还是属于复发。

    • 肝细胞癌的预后（恢复机会）和治疗选择取决于以下因素：

  • PRETEXT 组
  • 癌症是否已扩散到身体的其他部位，例如肺部。
  • 肿瘤是否能通过手术完全切除。
  • 癌症对化疗的反应。
  • 孩子是否患有乙型肝炎感染。
  • 癌症是刚刚被确诊断还是属于复发。

    • 对于初次治疗后复发（再次患病）的儿童肝癌患者，预后和治疗方案的选择取决于：

  • 肿瘤复发的部位。
  • 初次发病时的治疗措施。

    • 如果肿瘤体积较小且能够通过手术完全切除，儿童肝癌是可以治愈的。肝母细胞瘤比肝细胞癌更容易完全切除。

    Childhood Liver Cancer Treatment (PDQ®)

    General Information About Childhood Liver Cancer

    Childhood liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.

    The liver is one of the largest organs in the body. It has two lobes and fills the upper right side of the abdomen inside the rib cage. Three of the many important functions of the liver are:

  • To filter harmful substances from the blood so they can be passed from the body in stools and urine.
  • To make bile to help digest fats from food.
  • To store glycogen (sugar), which the body uses for energy.
    • Anatomy of the liver. The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas. The liver has a right lobe and a left lobe. Each lobe is divided into two sections (not shown).

    Liver cancer is rare in children and adolescents.

    There are different types of childhood liver cancer.

    There are two main types of childhood liver cancer:

  • Hepatoblastoma: Hepatoblastoma is the most common type of childhood liver cancer. It usually affects children younger than 3 years of age.

    • In hepatoblastoma, the histology (how the cancer cells look under a microscope) affects the way the cancer is treated. The histology for hepatoblastoma may be one of the following:

  • Well-differentiated fetal (pure fetal) histology.
  • Small cell undifferentiated histology.
  • Non–well-differentiated fetal histology, non-small cell undifferentiated histology.
  • Hepatocellular carcinoma: Hepatocellular carcinoma usually affects older children and adolescents. It is more common in areas of Asia that have high rates of hepatitis B infection than in the U.S.

    • Other less common types of childhood liver cancer include the following:

  • Undifferentiated embryonal sarcoma of the liver: This type of liver cancer usually occurs in children between 5 and 10 years of age. It often spreads all through the liver and/or to the lungs.
  • Infantile choriocarcinoma of the liver: This is a very rare tumor that starts in the placenta and spreads to the fetus. The tumor is usually found during the first few months of life. Also, the mother of the child may be diagnosed with choriocarcinoma. Choriocarcinoma is a type of gestational trophoblastic disease. See the PDQ summary on Gestational Trophoblastic Disease Treatment for more information on the treatment of choriocarcinoma for the mother of the child.
  • Vascular liver tumors: These tumors form in the liver from cells that make blood vessels or lymph vessels. Vascular liver tumors may be benign (not cancer) or malignant (cancer). See the PDQ summary on Childhood Vascular Tumors Treatment for more information on vascular liver tumors.

    • This summary is about the treatment of primary liver cancer (cancer that begins in the liver). Treatment of metastatic liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary.

    Primary liver cancer can occur in both adults and children. However, treatment for children is different from treatment for adults. See the PDQ summary on Adult Primary Liver Cancer Treatment for more information on the treatment of adults.

    Certain diseases and conditions can increase the risk of childhood liver cancer.

    Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk.

    Risk factors for hepatoblastoma include the following syndromes or conditions:

  • Aicardi syndrome.
  • Beckwith-Wiedemann syndrome.
  • Hemihyperplasia.
  • Familial adenomatous polyposis (FAP).
  • Glycogen storage disease.
  • A very low weight at birth.
  • Simpson-Golabi-Behmel syndrome.
  • Certain genetic changes, such as Trisomy 18.

    • Children at risk of hepatoblastoma may have tests done to check for cancer before any symptoms appear. Every 3 months until the child is 4 years old, an abdominal ultrasound exam is done and the level of alpha-fetoprotein in the blood is checked.

    Risk factors for hepatocellular carcinoma include the following syndromes or conditions:

  • Alagille syndrome.
  • Glycogen storage disease.
  • Hepatitis B virus infection that was passed from mother to child at birth.
  • Progressive familial intrahepatic disease.
  • Tyrosinemia.

    • Some patients with tyrosinemia will have a liver transplant to treat this disease before there are signs or symptoms of cancer.

    Signs and symptoms of childhood liver cancer include a lump or pain in the abdomen.

    Signs and symptoms are more common after the tumor gets big. Other conditions can cause the same signs and symptoms. Check with your child’s doctor if your child has any of the following:

  • A lump in the abdomen that may be painful.
  • Swelling in the abdomen.
  • Weight loss for no known reason.
  • Loss of appetite.
  • Nausea and vomiting.

    • Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer and find out whether the cancer has spread.

    The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Serum tumor marker test: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The blood of children who have liver cancer may have increased amounts of a hormone called beta-human chorionic gonadotropin (beta-hCG) or a protein called alpha-fetoprotein (AFP). Other cancers, benign liver tumors, and certain noncancer conditions, including cirrhosis and hepatitis, can also increase AFP levels.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver damage or cancer.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin or lactate dehydrogenase (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Epstein-Barr virus (EBV) test: A blood test to check for antibodies to the EBV and DNA markers of the EBV. These are found in the blood of patients who have been infected with EBV.
  • Hepatitis assay: A procedure in which a blood sample is checked for pieces of the hepatitis virus.
  • MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the liver. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
    • Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. In childhood liver cancer, a CT scan of the chest and abdomen is usually done.
    • Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. In childhood liver cancer, an ultrasound exam of the abdomen to check the large blood vessels is usually done.
    • Abdominal ultrasound. An ultrasound transducer connected to a computer is pressed against the skin of the abdomen. The transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).
  • Abdominal x-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
  • Biopsy: The removal of a sample of cells or tissues so it can be viewed under a microscope to check for signs of cancer. The sample may be taken during surgery to remove or view the tumor. A pathologist looks at the sample under a microscope to find out the type of liver cancer.

    • The following test may be done on the sample of tissue that is removed:

  • Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to check for a certain gene mutation, to help diagnose cancer, and to help tell one type of cancer from another type of cancer.

    • Certain factors affect prognosis (chance of recovery) and treatment options.

    The prognosis (chance of recovery) and treatment options for hepatoblastoma depend on the following:

  • The PRETEXT group.
  • The size of the tumor.
  • Whether the type of hepatoblastoma is well-differentiated fetal (pure fetal) or small cell undifferentiated histology.
  • Whether the cancer has spread to other places in the body, such as the diaphragm, lungs, or certain large blood vessels.
  • Whether there is more than one tumor in the liver.
  • Whether the outer covering around the tumor has broken open.
  • How the cancer responds to chemotherapy.
  • Whether the cancer can be removed completely by surgery.
  • Whether the patient can have a liver transplant.
  • Whether the AFP blood levels go down after treatment.
  • The age of the child.
  • Whether the cancer has just been diagnosed or has recurred.

    • The prognosis (chance of recovery) and treatment options for hepatocellular carcinoma depend on the following:

  • The PRETEXT group.
  • Whether the cancer has spread to other places in the body, such as the lungs.
  • Whether the cancer can be removed completely by surgery.
  • How the cancer responds to chemotherapy.
  • Whether the child has hepatitis B infection.
  • Whether the cancer has just been diagnosed or has recurred.

    • For childhood liver cancer that recurs (comes back) after initial treatment, the prognosis and treatment options depend on:

  • Where in the body the tumor recurred.
  • The type of treatment used to treat the initial cancer.

    • Childhood liver cancer may be cured if the tumor is small and can be completely removed by surgery. Complete removal is possible more often for hepatoblastoma than for hepatocellular carcinoma.

    儿童肝癌治疗(PDQ®)

    儿童肝癌的阶段

    儿童肝癌确诊后，需进行检查以确认癌细胞是否遍布肝脏或已转移至其他部位。

    用来确定癌症是否在肝脏内扩散到附近的组织或器官，或身体其他部位的过程称为分期。在儿童肝癌的治疗中，使用PRETEXT组和POSTTEXT组来代替分期治疗。用于检测、诊断和确定癌症是否已扩散的检测和程序的结果可用于确定PRETEXT组和POSTTEXT组。

    儿童肝癌有两种分型系统。

    儿童肝癌可采用两种分型系统来决定是否可以通过手术切除肿瘤：

  • PRETEXT组描述的是患者接受任何治疗前的肿瘤情况。
  • POSTTEXT组描述的是患者接受新辅助化疗等治疗后的肿瘤情况。

    • 有四个PRETEXT和POSTTEXT组：

    肝脏可分为四个部分。PRETEXT和POSTTEXT组取决于肝脏的哪些部位患有癌症。

    PRETEXT和POSTTEXT第一组

    肝脏PRETEXTI。在肝脏的一个部分发现了癌症。相邻的三个肝脏部分没有癌症。

    第一组，在肝脏的一个部分发现了癌症。相邻的三个肝脏部分没有癌症。

    PRETEXT和POSTTEXT第二组

    肝脏PRETEXTII。在肝脏的一或两个部分发现了癌症。相邻的两个肝脏部分没有癌症。

    第二组，在肝脏的一或两个部分发现了癌症。相邻的两个肝脏部分没有癌症。

    PRETEXT和POSTTEXT第三组

    肝脏PRETEXTIII。在肝脏的三个部分发现了癌症。一个肝脏部分没有癌症，或在肝脏的两个部分发现了癌症，不相邻的两个肝脏部分没有癌症。

    第三组，为以下情况之一：

  • 在肝脏的三个部分发现了癌症。一个肝脏部分没有癌症。
  • 在肝脏的两个部分发现了癌症，不相邻的两个肝脏部分没有癌症。

    • PRETEXT和POSTTEXT第四组

    肝脏PRETEXTIV。在肝脏的四个部分均发现了癌症。

    第四组，在肝脏的四个部分均发现了癌症。

    癌通过三种方式在体内扩散。

    癌可通过组织、淋巴系统和血液扩散：

  • 组织。癌从其起源处向周围生长扩散。
  • 淋巴系统。癌通过侵入淋巴系统从其起源处扩散，经淋巴管到达身体其他部位。
  • 血液。癌通过侵入血液从其起源处扩散，经血管到达身体其他部位。

    • 癌可从起源处扩散至身体其他部位。

    当癌扩散至身体的另一部位时，称之为转移。癌细胞从起源（原发癌）处脱离并通过淋巴系统或血液移动。

  • 淋巴系统。癌侵入淋巴系统，通过淋巴管移动，在身体另一部位形成肿瘤（转移癌）。
  • 血液。癌侵入血液，通过血管移动，在身体另一部位形成肿瘤（转移癌）。

    • 转移癌与原发肿瘤类型相同。例如，如儿童肝癌扩散至肺部，肺部的癌细胞其实是肝癌细胞。这种癌称为转移性肝癌，而不是肺癌。

    许多癌症死亡是由于癌从最初的肿瘤转移到其他组织和器官而造成的。这叫做转移癌。以下动画演示了癌细胞从其起源处转移至身体其他部位的方式。
    Childhood Liver Cancer Treatment (PDQ®)

    Stages of Childhood Liver Cancer

    After childhood liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.

    The process used to find out if cancer has spread within the liver, to nearby tissues or organs, or to other parts of the body is called staging. In childhood liver cancer, the PRETEXT and POSTTEXT groups are used instead of stage to plan treatment. The results of the tests and procedures done to detect, diagnose, and find out whether the cancer has spread are used to determine the PRETEXT and POSTTEXT groups.

    There are two grouping systems for childhood liver cancer.

    Two grouping systems are used for childhood liver cancer to decide whether the tumor can be removed by surgery:

  • The PRETEXT group describes the tumor before the patient has any treatment.
  • The POSTTEXT group describes the tumor after the patient has had treatment such as neoadjuvant chemotherapy.

    • There are four PRETEXT and POSTTEXT groups:

    The liver is divided into four sections. The PRETEXT and POSTTEXT groups depend on which sections of the liver have cancer.

    PRETEXT and POSTTEXT Group I

    Liver PRETEXT I. Cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them.

    In group I, the cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them.

    PRETEXT and POSTTEXT Group II

    Liver PRETEXT II. Cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them.

    In group II, cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them.

    PRETEXT and POSTTEXT Group III

    Liver PRETEXT III. Cancer is found in three sections of the liver and one section does not have cancer, or cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.

    In group III, one of the following is true:

  • Cancer is found in three sections of the liver and one section does not have cancer.
  • Cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.

    • PRETEXT and POSTTEXT Group IV

    Liver PRETEXT IV. Cancer is found in all four sections of the liver.

    In group IV, cancer is found in all four sections of the liver.

    There are three ways that cancer spreads in the body.

    Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

    • Cancer may spread from where it began to other parts of the body.

    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

    • The metastatic tumor is the same type of cancer as the primary tumor. For example, if childhood liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer.

    Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.
    儿童肝癌治疗(PDQ®)

    复发性儿童肝癌

    复发性儿童肝癌是指治疗后复发的癌症。癌症可能会在肝脏或身体其他部位复发。在治疗过程中不断增长或恶化的癌症是进行性疾病。

    Childhood Liver Cancer Treatment (PDQ®)

    Recurrent Childhood Liver Cancer

    Recurrent childhood liver cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the liver or in other parts of the body. Cancer that is growing or worsening during treatment is progressive disease.

    儿童肝癌治疗(PDQ®)

    治疗方案综述

     对于儿童肝癌患者，有不同类型的疗法。

    有不同类型的疗法可供肝癌患病儿童选择。一些属于标准疗法（正在使用中的疗法），一些还处于临床试验阶段。临床试验是一种研究性课题，旨在帮助提升现有疗法或为癌症患者获取新型疗法的相关信息。当临床试验显示新疗法比标准疗法更好时，新疗法可成为标准疗法。

    所有患有肝癌的儿童都应考虑参加某项临床试验。有些临床试验只对尚未开始治疗的患者开放。

    肝癌患病儿童的治疗计划应由治疗这种罕见儿童癌症的健康护理专家组完成。

    治疗将在儿科肿瘤医生，也就是专门治疗患癌儿童医生的监督下进行。该儿童肿瘤医生与其他儿童肝癌治疗专家和特定药物领域专家合作，提供健康护理服务。与拥有肝脏手术经验的儿科外科医生合作是尤其重要的，该医生可在需要时将病人转移至肝移植项目中。其他专家可能包括以下：

  • 儿科医师。
  • 放射肿瘤学家。
  • 儿科护理专家。
  • 康复科专家。
  • 心理学家。
  • 社工。

    • 儿童肝癌的治疗可能会引起副作用。

    有关癌症治疗期间开始出现的副作用的信息，请参阅我们的副作用页面。

    癌症治疗的副作用在治疗后开始并持续数月或数年，称为晚期效应。癌症治疗的晚期效应可能包括：

  • 生理问题。
  • 情绪、感觉、思考、学习或记忆方面的变化。
  • 二次癌症（新的癌症）

    • 一些晚期效应可以得到治疗或控制。重要的是要与孩子的医生商谈癌症治疗可能对孩子造成的影响。(更多信息请见PDQ儿童癌症治疗的晚期效应摘要)

    使用中的六种标准疗法有：

    手术

    若情况允许，通过手术移除肿瘤。

  • 肝部分切除术：切除患癌的部分肝脏。切除的部分可能是楔形组织、整个肝叶或肝脏大部，以及肝周围粘连少量正常组织。
  • 全肝切除和肝移植：切除整个肝脏，然后从供体移植健康肝脏。 当癌症还没有扩散到肝脏以外并且可以找到捐献的肝脏时，可以进行肝脏移植。 如果患者必须等待捐赠的肝脏，则可以根据需要进行其他治疗。
  • 转移瘤切除术：通过手术对已经扩散至肝外（例如，周围组织、肺、脑）的肿瘤进行移除。

    • 可以进行的手术类型取决于以下内容：

  • PRETEXT组和POSTTEXT组。
  • 原发肿瘤的大小。
  • 肝脏是否存在不止一处肿瘤。
  • 癌症是否已扩散到附近的大血管。
  • 血液中甲胎蛋白（AFP）的水平。
  • 能否通过化疗使肿瘤缩小并进行手术移除。
  • 是否需要进行肝移植。

    • 有时在手术前进行化疗，以缩小肿瘤，使其更容易切除，称为新辅助疗法。

    在医生在手术时会切除所有能看到的癌细胞，一些患者可能会在手术后接受化疗或放射治疗，以杀死任何残留的癌细胞。为了降低癌症复发的风险，术后给予的治疗称为辅助治疗。

    等待观察

    等待观察指密切监测患者的病情，而不给予任何治疗，直到症状或体征出现或改变。在肝母细胞瘤中，这种治疗方法仅适用于已经通过手术完全切除的小型肿瘤。

    化疗

    化学药物治疗是一种用药物来阻止（或通过杀死癌细胞，或通过阻止癌细胞分裂）癌细胞生长的癌症治疗方法。当化学疗法通过口服或注射到静脉或肌肉中时，药物进入血液并能到达全身的癌细胞（全身性化疗）。当直接进入脑脊液、器官或腹腔等体腔时，药物主要影响这些区域的癌细胞（区域化疗）。使用不止一种抗癌药物的治疗称为联合化疗。

    肝动脉（向肝脏供血的主要动脉）的化学栓塞术是一种区域化疗，用于治疗无法通过手术切除的儿童肝癌。通过导管（细管）将抗癌药注入肝动脉。该药物与阻塞动脉的物质混合，切断了流向肿瘤的血液。大多数抗癌药物都被困在肿瘤附近，只有少量的药物到达了身体的其他部位。根据用于阻塞动脉的物质，阻塞可以是暂时的也可以是永久的。这样肿瘤无法获得生长所需的氧气和营养。肝脏继续接受来自肝门静脉的血液，肝门静脉将血液从胃和肠输送到肝脏。这一方法也称为经动脉化疗栓塞术或TACE。

    化疗的方式取决于所治疗癌症的类型以及PRETEXT或POSTTEXT组

    放射治疗

    放射治疗是一种利用高能x射线或其他类型的辐射杀死或阻止癌细胞生长的癌症治疗方法。放射治疗有两种类型：

  • 外部放射疗法使用体外的机器向癌细胞发送辐射。
  • 内部放射疗法使用密封在针头、种子、金属丝或导管中的放射性物质，直接置于癌细胞中或其附近。

    • 肝动脉（为肝脏供血的主动脉）放射性栓塞是一种用于治疗儿童肝癌的内部放射疗法。将沾取少量放射性物质的微珠通过导管（细管）注入肝动脉。微珠与肝动脉阻断物质混合，切断肿瘤的血液供应。大部分放射物质固定在肿瘤周围以杀死癌细胞。这种疗法用来减轻肝细胞癌患病儿童的症状，提高其生活质量。

    放射治疗的方式取决于所治疗癌症的类型以及PRETEXT或POSTTEXT组。外部放射疗法用于治疗不能通过手术切除或已扩散到身体其他部位的肝母细胞瘤。

    消融治疗

    消融治疗可去除或破坏组织。不同类型的消融治疗可用于肝癌：

  • 射频消融：使用特殊的针头直接插入皮肤或通过腹部切口插入肿瘤。高能无线电波加热针头和肿瘤，杀死癌细胞。射频消融被用于治疗复发性肝母细胞瘤。
  • 经皮乙醇注射：用小针头将乙醇（纯酒精）直接注射到肿瘤中杀死癌细胞。治疗可能需要多次注射。经皮注射乙醇治疗复发性肝母细胞瘤。

    • 抗病毒治疗

    与乙型肝炎病毒有关的肝细胞癌可以用抗病毒药物治疗。

    临床试验正在对新疗法进行测试。

    该概述部分描述了临床试验中正在研究的治疗方法。 可能没有提及正在研究的每种新疗法。 有关临床试验的信息可从NCI网站获得。

    靶向治疗

    靶向治疗是一种利用药物或其他物质攻击特定癌细胞的治疗方法。酪氨酸激酶抑制剂(TKI)治疗是一种靶向治疗。TKIs阻断肿瘤生长所需的信号。索拉非尼和帕唑帕尼是正在研究的用于治疗复发的肝细胞癌和新诊断的肝未分化胚胎性肉瘤的TKI。

    患者可能希望对参加临床试验进行考虑。

    对于一些患者来说，参加临床试验可能是最好的治疗选择。临床试验是癌症研究过程的一部分，目的是查明癌症新疗法是否安全有效或比标准疗法更好。

    今天许多癌症标准疗法都是基于之前的临床试验。参加临床试验的患者可能得到标准治疗或能得到新疗法的优先尝试权。

    参加临床试验的患者也是在帮助提升未来对癌症的治疗。即使临床试验未能找到有效的新疗法，通常也会解答重要问题，促进研究前进。

    患者可以在开始癌症治疗之前、期间或之后参加临床试验。

    一些临床试验只接收还未开始治疗的患者。其他试验为癌症还未得到好转的患者提供疗法测试。也有一些临床试验针对防止癌症复发（再生）或减少癌症治疗副作用的新疗法提供测试。

    临床试验正在全国许多地方进行。在NCI的临床试验搜索网页上可以找到有关NCI支持的临床试验的信息。其他组织支持的临床试验可以在Clinical trials.gov网站上找到。

    可能需要的跟踪续检查

    有些重复进行的检查是为了诊断癌症或找出治疗组；有些是为了观察治疗效果。是否继续、改变或停止治疗的决定可能均基于这些检查的结果。

    治疗结束后会持续不定期地进行一些检查。这些检查的结果可以显示孩子的状况是否发生改变或癌症是否复发（再次产生）。这些检查有时被称作跟进检查或身体检查。

    Childhood Liver Cancer Treatment (PDQ®)

    Treatment Option Overview

    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.

    • Treatment for childhood liver cancer may cause side effects.

    For information about side effects that begin during treatment for cancer, see our Side Effects page.

    Side effects from cancer treatment that begin 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.

    • The type of surgery that can be done depends on 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.

    After 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 patient’s 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 that cannot be removed by surgery. 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 to the liver. 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.

    • 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.

    The way the radiation therapy is given depends on the type of the cancer being treated and the PRETEXT or POSTTEXT group. 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. Treatment may require several injections. 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. Tyrosine kinase inhibitor (TKI) therapy is a type of targeted therapy. TKIs block signals needed for tumors to grow. Sorafenib and pazopanib are TKIs being studied for the treatment of hepatocellular carcinoma that has come back and newly diagnosed undifferentiated embryonal sarcoma of the liver.

    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. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

    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 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.

    儿童肝癌治疗(PDQ®)

    儿童肝癌治疗方案

    有关以下所列治疗的信息，请参阅“治疗方案概述”部分。

    肝母细胞瘤

    在诊断时可通过手术切除的肝母细胞瘤的治疗方案择可能包括以下几种：

  • 对于胎儿组织学不完全分化的肝母细胞瘤，手术切除肿瘤，然后联合化疗治疗。对于小细胞未分化的肝母细胞瘤，应进行积极的化疗。
  • 对胎儿组织学分化良好的肝母细胞瘤，手术切除肿瘤，随后观察等待或化疗。

    • 不能通过手术切除或在诊断时不能切除的肝母细胞瘤的治疗方案包括：

  • 通过联合化疗使肿瘤缩小，然后手术移除肿瘤。
  • 联合化疗，然后肝移植。
  • 采用肝动脉化疗栓塞术治疗使肿瘤缩小，然后手术移除肿瘤。
  • 如果肝脏的肿瘤不能通过手术切除，且身体其他部位没有癌症的迹象，治疗方法可采用肝移植。

    • 对于诊断时已扩散到身体其他部位的肝母细胞瘤，给予联合化疗以缩小肝脏肿瘤和扩散到身体其他部位的癌症。化疗后，进行影像学检查，查看肿瘤是否可以通过手术切除。

    治疗方案可能包括以下几种：

  • 如果肝脏和身体其他部位的肿瘤（通常是肺部的结节）可以切除，手术切除肿瘤，然后进行化疗，以杀死可能残留的癌细胞。
  • 如果身体其他部位的肿瘤不能切除或不能进行肝移植，可以进行化疗、肝动脉化疗栓塞或放射治疗。
  • 如果身体其他部位的肿瘤不能切除或患者不想进行手术，可以进行射频消融治疗。

    • 新确诊的肝母细胞瘤的临床试验中的治疗方案包括：

  • 化疗和外科手术临床试验

    • 肝细胞癌

    诊断时可通过手术切除的肝细胞癌的治疗方案包括：

  • 仅手术切除肿瘤
  • 手术移除肿瘤，然后进行化疗。
  • 进行联合化疗，然后手术移除肿瘤。

    • 无法通过手术切除且在诊断时尚未扩散到身体其他部位的肝细胞癌的治疗方案可能包括以下几种：

  • 进行化疗使肿瘤缩小，然后进行手术彻底清除肿瘤。
  • 进行化疗使肿瘤缩小。如果无法通过手术完全移除肿瘤，进一步的治疗手段可能包括：
  • 肝移植。
  • 采用肝动脉化学栓塞术使肿瘤缩小，然后进行手术切除肿瘤或进行肝移植。
  • 仅采用肝动脉的化学栓塞术
  • 先采用化学栓塞，然后进行肝移植。
  • 肝动脉栓塞作为姑息性治疗，缓解症状，提高生活质量。

    • 在诊断时已扩散到身体其他部位的肝细胞癌的治疗可能包括：

  • 联合化疗以缩小肿瘤，然后进行手术以从肝脏和其他癌症扩散的地方尽可能多地切除肿瘤。研究未表明此种治疗效果很好，但某些患者可能会受益。

    • 与乙型肝炎病毒(HBV)感染相关的肝细胞癌的治疗方案包括：

  • 手术切除肿瘤
  • 治疗乙型肝炎病毒感染的抗病毒药物

    • 新确诊的肝细胞癌在临床试验中的治疗方案包括：

  • 化疗和手术的临床试验

    • 肝脏未分化胚胎性肉瘤

    肝未分化胚胎性肉瘤的治疗方案包括：

  • 联合化疗以缩小肿瘤，然后进行手术以尽可能多地切除肿瘤。手术后也可以进行化学疗法以去除肿瘤。
  • 手术切除肿瘤，然后进行化疗。 可以进行第二次手术以去除残留的肿瘤，然后进行更多的化疗。
  • 如果无法手术移除肿瘤，则进行肝移植。
  • 新治疗方案的临床试验，可能包括术前靶向治疗（帕唑帕尼）、化疗和/或放疗。

    • 婴儿肝脏绒毛膜癌

    婴儿肝绒毛膜癌的治疗方案包括：

  • 通过联合化疗使肿瘤缩小，然后手术移除肿瘤。
  • 手术切除肿瘤

    • 血管性肝癌

    有关血管性肝肿瘤治疗的信息，请参阅儿童血管性肿瘤治疗的PDQ概要。

    复发性儿童肝癌

    进行性或复发性肝母细胞瘤的治疗可包括：

  • 配合或不配合化疗，手术切除孤立的（单个及分开的）转移性肿瘤。
  • 射频消融
  • 联合化疗。
  • 肝移植。
  • 消融疗法（射频消融或经皮乙醇注射）作为姑息疗法，可缓解症状并提高生活质量。
  • 检查患者肿瘤样本中某些基因变化的临床试验。将给予患者的靶向治疗的类型取决于基因改变的类型。

    • 进行性或复发性肝细胞癌的治疗可包括：

  • 采用肝动脉化疗栓塞缩小肿瘤，然后进行肝移植。
  • 肝移植。
  • 靶向治疗（索拉非尼）的临床试验。
  • 检查患者肿瘤样本中某些基因变化的临床试验。将给予患者的靶向治疗的类型取决于基因改变的类型。

    • 肝脏复发性未分化胚胎肉瘤的治疗可包括：

  • 检查患者肿瘤样本中某些基因变化的临床试验。将给予患者的靶向治疗的类型取决于基因改变的类型。

    • 婴儿复发性肝绒毛膜癌的治疗可包括：

  • 检查患者肿瘤样本中某些基因变化的临床试验。将给予患者的靶向治疗的类型取决于基因改变的类型。

    • 临床试验中的治疗方案

    使用我们的临床试验搜索来查找NCI支持（正在接受患者）的癌症临床试验。您可以根据癌症类型、患者年龄以及进行试验的地点搜索试验。也可以获取有关临床试验的一般信息。

    Childhood Liver Cancer Treatment (PDQ®)

    Treatment Options for Childhood Liver Cancer

    For information about the treatments listed below, see the Treatment Option Overview section.

    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 combination chemotherapy for hepatoblastoma that is not well-differentiated fetal histology. For hepatoblastoma with small cell undifferentiated histology, aggressive chemotherapy is given.
  • Surgery to remove the tumor, followed by watchful waiting or chemotherapy, for hepatoblastoma with well-differentiated fetal histology.

    • 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.
  • If the tumor 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.

    • For hepatoblastoma that has spread to other parts of the body at the time of diagnosis, combination chemotherapy is given to shrink the tumors in the liver and cancer that has spread to other parts of the body. After chemotherapy, imaging tests are done to check whether the tumors can be removed by surgery.

    Treatment options may include the following:

  • If the tumor in the liver and other parts of the body (usually nodules in the lung) can be removed, surgery will be done to remove the tumors followed by chemotherapy to kill any cancer cells that may remain.
  • If the tumor 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.
  • If the tumor in other parts of the body cannot be removed or the patient does not want surgery, radiofrequency ablation may be given.

    • Treatment options in clinical trials for newly diagnosed hepatoblastoma include:

  • A clinical trial of chemotherapy and surgery.

    • 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 and has not spread to other parts of the body 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 the tumor or liver transplant.
  • Chemoembolization of the hepatic artery alone.
  • Chemoembolization followed by liver transplant.
  • 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.

    • Treatment options in clinical trials for newly diagnosed hepatocellular carcinoma include:

  • A clinical trial of chemotherapy and surgery.

    • Undifferentiated Embryonal Sarcoma of the Liver

    Treatment options for undifferentiated embryonal sarcoma of the liver 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 new treatment regimen that may include targeted therapy (pazopanib), 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.

    • Vascular Liver Tumors

    See the PDQ summary on Childhood Vascular Tumors Treatment for information on the treatment of vascular liver tumors.

    Recurrent Childhood Liver Cancer

    Treatment of progressive or recurrent hepatoblastoma may include the following:

  • Surgery to remove isolated (single and separate) metastatic tumors with or without chemotherapy.
  • Radiofrequency ablation.
  • Combination chemotherapy.
  • Liver transplant.
  • Ablation therapy (radiofrequency ablation or percutaneous ethanol injection) as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

    • 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 targeted therapy (sorafenib).
  • A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

    • Treatment of recurrent undifferentiated embryonal sarcoma of the liver may include the following:

  • A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

    • Treatment of recurrent choriocarcinoma of the liver in infants may include the following:

  • A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

    • Treatment Options in Clinical Trials

    Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    儿童肝癌治疗(PDQ®)

    儿童肝癌更多知识

    更多美国国家癌症研究所（NCI）儿童肝癌信息，请见以链接：

  • 肝胆管癌主页
  • 计算机断层扫描（CT scans）与癌症
  • MyPART-我的儿科和成人罕见肿瘤网络

    • 更多儿童癌症信息和其他癌症一般资源，请见以下链接：

  • 关于癌症
  • 儿童癌症
  • 儿童癌症疗法搜寻
  • 儿童癌症治疗的后期效果
  • 患癌青少年
  • 患有癌症的儿童：父母指南
  • 儿童癌症与青少年癌症
  • 分期
  • 应对癌症
  • 可向医生询问有关癌症的问题
  • 幸存者与护理人员知识库
    • Childhood Liver Cancer Treatment (PDQ®)

    To Learn More About Childhood Liver Cancer

    For more information from the National Cancer Institute about childhood liver cancer, see the following:

  • Liver and Bile Duct Cancer Home Page
  • Computed Tomography (CT) Scans and Cancer
  • MyPART - My Pediatric and Adult Rare Tumor Network

    • For more childhood cancer information and other general cancer resources, see the following:

  • About Cancer
  • Childhood Cancers
  • CureSearch for Children's Cancer
  • Late Effects of Treatment for Childhood Cancer
  • Adolescents and Young Adults with Cancer
  • Children with Cancer: A Guide for Parents
  • Cancer in Children and Adolescents
  • Staging
  • Coping with Cancer
  • Questions to Ask Your Doctor about Cancer
  • For Survivors and Caregivers
    • 儿童肝癌治疗(PDQ®)

    About This PDQ Summary

    About PDQ

    Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

    PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

    Purpose of This Summary

    This PDQ cancer information summary has current information about the treatment of childhood liver cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

    Reviewers and Updates

    Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

    The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

    Clinical Trial Information

    A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

    Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

    Permission to Use This Summary

    PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

    The best way to cite this PDQ summary is:

    PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Liver Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/liver/patient/child-liver-treatment-pdq. Accessed . [PMID: 26389318]

    Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

    Disclaimer

    The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

    Contact Us

    More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

    Childhood Liver Cancer Treatment (PDQ®)

    About This PDQ Summary

    About PDQ

    Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

    PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

    Purpose of This Summary

    This PDQ cancer information summary has current information about the treatment of childhood liver cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

    Reviewers and Updates

    Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

    The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

    Clinical Trial Information

    A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

    Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

    Permission to Use This Summary

    PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

    The best way to cite this PDQ summary is:

    PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Liver Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/liver/patient/child-liver-treatment-pdq. Accessed . [PMID: 26389318]

    Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

    Disclaimer

    The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

    Contact Us

    More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

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    章 节
    儿童肝癌概况 儿童肝癌的阶段 复发性儿童肝癌 治疗方案综述 儿童肝癌治疗方案 儿童肝癌更多知识 About This PDQ Summary
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