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The most common type of liver tumours are hepatoblastomas, a type of embryonal tumour. The remainder are hepatic carcinomas.
In addition to hepatoblastoma and hepatic carcinoma, other types of childhood cancer can occur with the liver as the primary site. These include soft tissue sarcomas, lymphomas, neuroblastoma and germ-cell tumours. Inclusion of these tumours increases the total incidence of liver cancer in childhood by about a quarter.
Hepatoblastoma and hepatic carcinomas are primary tumours. The liver is a common site for the development of secondary tumours that spread (metastasise) from another site. These secondary tumours are not classified as hepatic tumours.
The causes of primary cancers of the liver are not fully understood. Some reports suggest associations between environmental exposures and hepatoblastoma, including parental occupational exposure to metals, petroleum products and paints or pigments.
There also appears to be an association between hepatoblastoma and low birth weight. A very small number of cases of hepatoblastoma occur in association with congenital anomalies and familial conditions.
Hepatic carcinomas are more common in countries that have a high incidence of hepatitis B. Children who are infected with hepatitis B have a higher risk of developing hepatic carcinoma than uninfected children.
In Great Britain, liver cancer (hepatic tumours) are quite rare, accounting for 1% of childhood cancers, with up to 20 new cases diagnosed every year in the UK. This group is broadly divided into hepatoblastoma and hepatic carcinoma, which account for around four-fifths (81%) and one-fifth (18%) of cases, respectively.
Younger children aged under 4 years are at a higher risk than older children from hepatic tumours in general. In children in the UK there are around 12 cases a year in girls and 16 cases in boys. In teenagers and young adults in the UK there are around 4 cases in females and 5 cases in males each year
Hepatoblastoma is the rarest of the four principal embryonal tumours, and is most likely to be diagnosed in children under two years of age.
Incidence of hepatoblastoma is highest in the under-3 age group, declining steeply thereafter. Hepatoblastoma is more common in boys.
Incidence of hepatic carcinoma increases with age, with the majority of cases diagnosed at 10-14 years. Boys and girls are affected equally.
Liver cancer survival rates
Overall, children’s five-year survival rates in England from liver tumours is 73%.
Within this, the rate for hepatoblastoma is better at around 80%.
The outlook for children with hepatic carcinoma, however, is very poor – less than 30 per cent of children survive.