The liver is a vital organ located in the upper right side of the abdomen. In an adult, it weighs about 1.2 kg. It is one of the most important organs in the body and keeps us healthy by performing many essential functions.
Hearing that your child may have a liver tumour can be frightening. The most important thing for parents to know is that liver cancers in children are very different from those in adults, and most children can be cured with modern treatment.
In most cases, parents are the first to notice that something is not quite right.
The commonest early sign is a gradually increasing tummy size (abdominal distension). The child may otherwise look well and active. In the early stages, the lump may not be easily felt by the doctor, and an ultrasound scan of the abdomen is usually the first test that helps detect the tumour.
Some children may also have:
∙Poor appetite
∙Mild discomfort or fullness in the abdomen
Unlike adult liver disease, children with liver tumours rarely develop jaundice, vomiting of blood, or other signs of chronic liver disease.
As the tumour grows, the abdomen may become more noticeably swollen, and the doctor may feel a firm lump on examination.
Most hepatoblastomas produce a substance called alpha-fetoprotein (AFP), which can be measured with a simple blood test.
High AFP levels support the diagnosis
AFP is also very useful to monitor response to treatment
A return of AFP to normal levels usually indicates excellent treatment response or complete remission
Other imaging tests such as CT or MRI scans help doctors understand the size and position of the tumour and plan treatment.
Chemotherapy is the main first step in treating liver tumours such as hepatoblastoma. Today, doctors follow international treatment plans developed by the SIOPEL group (International Society of Paediatric Oncology – Liver Tumour Group). These plans are designed to give the best cure rates with the least long-term side effects. Importantly, not all children receive the same chemotherapy. The number of cycles and medicines used depend on how much of the liver is involved and whether the tumour has spread.
Using scans (CT or MRI), the liver is divided into sections. Based on how many sections are involved, children are grouped into standard-risk or high-risk categories.
This allows treatment to be personalised, rather than “one size fits all”.
This is the most common situation.
Chemotherapy plan:
4 cycles before surgery
2 cycles after surgery
Total: 6 cycles
Main drug used:
Cisplatin
In many children, cisplatin alone is sufficient to shrink the tumour and achieve cure. This approach has been shown to be very effective while reducing long-term toxicity.
This includes:
Tumours involving most of the liver
Tumours that have spread outside the liver
Tumours not responding well to initial treatment
Chemotherapy plan:
6–7 cycles in total
∙Given both before and after surgery or liver transplantation
Drugs commonly used:
Cisplatin
Doxorubicin
Sometimes carboplatin in selected situations
These combinations are stronger and are used when the tumour needs more intensive treatment.
After four cycles of chemotherapy, the tumour is reassessed.
If the tumour is in a favourable position, surgical removal of the affected part of the liver is performed
If the tumour is very large or close to important blood vessels or bile ducts, complete removal may not be possible
In such situations, liver transplantation becomes the best and safest option for cure
Both surgery and transplantation in children have excellent outcomes when done in experienced centres.
After surgery or liver transplantation:
Two additional cycles of chemotherapy are given
This reduces the risk of cancer coming back
Helps ensure long-term cure
Both surgery and transplantation in children have excellent outcomes when done in experienced centres.
Doctors around the world follow international treatment guidelines developed by experts. One such widely used system is called SIOPEL. Here we follow the SIOPEL protocol.
For parents, this simply means:
The tumour is first carefully assessed using scans
Children are grouped based on how much of the liver is involved
Chemotherapy is given first to shrink the tumour
Surgery or liver transplant is then planned at the safest time
Treatment is tailored so that every child gets the best chance of cure with the least risk
This approach ensures that treatment is planned, stepwise, and safe, rather than rush
A liver biopsy is a simple medical test in which doctors take a tiny sample of liver tissue to examine under a microscope. This helps doctors:
1. Anatomical Liver and Bile Duct Disorders
Understand the exact cause of a liver problem
Assess how severe the liver condition is
Monitor how well treatment is working
The procedure is usually done under local anaesthesia or short sedation, so the child does not feel pain. A special needle is used to safely collect a very small piece of liver tissue.
After the biopsy, your child will be closely observed for a few hours. Most children are able to go home the same day, usually after about 6 hours, if everything is stable.
Progressive Familial Intrahepatic Cholestasis (PFIC)
Alagille syndrome
These disorders affect bile flow and can present with jaundice very early in life.
3. Metabolic Liver Disorders
Your child will need to fast for at least 6 hours
The biopsy is done by prior appointment
Blood tests are checked beforehand to ensure safety
Doctors and nurses take every precaution to make this procedure as safe and comfortable as possible.
Endoscopy is a procedure that allows doctors to look inside the digestive system using a thin, flexible tube with a tiny camera at the tip, called an endoscope.
It helps doctors:
Take small tissue samples (biopsies) if needed
Stop bleeding
Remove abnormal growths such as polyps
Endoscopy is usually a day-care procedure, meaning your child can go home the same day after a short period of observation.
An upper GI endoscopy examines the:
Food pipe (oesophagus)
Stomach
First part of the small intestine (duodenum)
In children with liver disease, increased pressure in the blood vessels of the digestive tract (called portal hypertension ) can cause veins in the food pipe or stomach to become enlarged and fragile. These swollen veins, known as varices, can sometimes bleed suddenly.
Using an upper GI endoscopy, doctors can:
Detect enlarged or bleeding veins early
Control bleeding by placing tiny rubber bands or special medical glue
Prevent serious complications
While adults may undergo this test while awake, children are given sedation or anaesthesia to ensure comfort and safety. Special paediatric endoscopes allow this procedure to be performed safely even in newborn babies.
A colonoscopy is a test used to examine the large intestine (colon). In children, it is commonly done to investigate:
Chronic or unexplained diarrhea
Blood in stools
Inflammatory bowel diseases (such as Crohn’s disease or ulcerative colitis)
Other ongoing bowel symptoms
Your child will be under sedation or general anaesthesia
A flexible camera is gently passed through the anus into the colon
The doctor carefully examines the bowel lining
Small tissue samples (biopsies) may be taken if required
Polyps or other abnormalities can be treated at the same time
After the procedure, your child will be monitored until fully awake and comfortable, and can usually go home the same day.
These procedures are commonly performed in children and are carried out by experienced paediatric specialists using child-friendly equipment. Your child’s comfort and safety are always the highest priority, and the medical team will guide you through every step.
A liver biopsy is a simple medical test in which doctors take a tiny sample of liver tissue to examine under a microscope. This helps doctors:
1. Anatomical Liver and Bile Duct Disorders
Understand the exact cause of a liver problem
Assess how severe the liver condition is
Monitor how well treatment is working
The procedure is usually done under local anaesthesia or short sedation, so the child does not feel pain. A special needle is used to safely collect a very small piece of liver tissue.
After the biopsy, your child will be closely observed for a few hours. Most children are able to go home the same day, usually after about 6 hours, if everything is stable.
Progressive Familial Intrahepatic Cholestasis (PFIC)
Alagille syndrome
These disorders affect bile flow and can present with jaundice very early in life.
3. Metabolic Liver Disorders
Your child will need to fast for at least 6 hours
The biopsy is done by prior appointment
Blood tests are checked beforehand to ensure safety
Doctors and nurses take every precaution to make this procedure as safe and comfortable as possible.
Endoscopy is a procedure that allows doctors to look inside the digestive system using a thin, flexible tube with a tiny camera at the tip, called an endoscope.
It helps doctors:
Take small tissue samples (biopsies) if needed
Stop bleeding
Remove abnormal growths such as polyps
Endoscopy is usually a day-care procedure, meaning your child can go home the same day after a short period of observation.
An upper GI endoscopy examines the:
Food pipe (oesophagus)
Stomach
First part of the small intestine (duodenum)
In children with liver disease, increased pressure in the blood vessels of the digestive tract (called portal hypertension ) can cause veins in the food pipe or stomach to become enlarged and fragile. These swollen veins, known as varices, can sometimes bleed suddenly.
Using an upper GI endoscopy, doctors can:
Detect enlarged or bleeding veins early
Control bleeding by placing tiny rubber bands or special medical glue
Prevent serious complications
While adults may undergo this test while awake, children are given sedation or anaesthesia to ensure comfort and safety. Special paediatric endoscopes allow this procedure to be performed safely even in newborn babies.
A colonoscopy is a test used to examine the large intestine (colon). In children, it is commonly done to investigate:
Chronic or unexplained diarrhea
Blood in stools
Inflammatory bowel diseases (such as Crohn’s disease or ulcerative colitis)
Other ongoing bowel symptoms
Your child will be under sedation or general anaesthesia
A flexible camera is gently passed through the anus into the colon
The doctor carefully examines the bowel lining
Small tissue samples (biopsies) may be taken if required
Polyps or other abnormalities can be treated at the same time
After the procedure, your child will be monitored until fully awake and comfortable, and can usually go home the same day.
These procedures are commonly performed in children and are carried out by experienced paediatric specialists using child-friendly equipment. Your child’s comfort and safety are always the highest priority, and the medical team will guide you through every step.
