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Hepatocellular carcinoma (HCC) is a rare childhood liver tumor occurring much less frequently than hepatoblastoma (HB). Together, HCC and HPB make up approximately one percent of all pediatric malignancies although HCC is much rarer in children . The pediatric surgeon will rarely encounter HCC in a child but should be prepared to know in what circumstances it is likely to be one encountered.
HCC occurs more frequently in adults and there is more literature published from data in that population. HCC presenting in children is different from that in adults. Except in certain areas of the world (e.g. Asia) children do not have predisposing conditions such as viral hepatitis . Cholestasis is associated with an increased the incidence of HCC in children . The pediatric surgeon should know the particularities of this disease in the pediatric population as findings derived from the adult experience may not apply.
Which aspects of hepatocellular carcinoma are most challenging for the pediatric surgeon?
For the surgeon complete removal of the tumor remains the reward and the challenge. Chemotherapy in children is not as effective in HCC as it is in HB and surgery must be aimed at complete removal of the tumor from the outset. In the future the therapeutic landscape for HCC may change so that the chemotherapeutic agents effective for HB will become equally effective for HCC.
Content in this topic is referenced in SCORE Malignant Liver Tumors: Hepatoblastoma/Hepatocellular Carcinoma overview