We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
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Liver tumours in children and adolescents can be benign and malignant. They are considered rare tumours (for every million children, only one will suffer from a malignant liver tumour), which is why they should be treated in centres with great experience in hepatic surgery, and ideally with a liver transplant programme for children. Additionally, they must have the latest advances in interventional radiology.
There are several types of tumour, which dictates prognosis and treatment. Malignant tumours, hepatoblastoma and hepatocarcinoma are the most frequent, accounting for 2/3 of all liver tumours. Benign tumours include haemangiomas, hamartomas and focal hyperplasia. In the case of benign tumours, especially those of a vascular nature (haemangiomas), vascular and interventionist radiology plays a decisive role, being able to avoid unnecessary surgical procedures, improving the prognosis and avoiding liver transplants.
Surgical treatment is an essential part of the cure of most malignant cases, and liver transplants can be the only possibility for curing some patients. Interventional radiology techniques also play an important role. Vall d’Hebron Hospital has gained considerable experience in treating these tumours and is involved in the first global study to treat hepatic malignant tumours for children (PHITT), being one of the reference centres for this pathology in Spain within the European ERN networks.
Patients usually present with abdominal distension, a palpable abdominal mass, or both. Weight loss, non-focus fever and loss of appetite are also common. Sometimes they can also be discovered incidentally when performing an ultrasound for another reason. If there is any accompanying liver disease or the bile duct is compressed, a yellowish colouration of the skin and mucous membranes (jaundice) may appear. Some patients may present with abdominal pain.
It can affect children of any age, even newborns. Tumour types are different at the different stages of life (newborns, young children and adolescents). Haemangiomas (benign tumours) are more frequent in premature children. Some malignant tumours are associated with liver and metabolism diseases, as well as genetic and hereditary syndromes or with vascular anomalies.
The tumour is generally detected by the primary care paediatrician, who will refer the patient for evaluation. Diagnoses can sometimes be established in a prenatal ultrasound or shortly after birth. Lastly, it can be detected in routine clinical controls in children with illnesses related to the development of these tumours. When the patient presents a malignant tumour, it will be important to complete the study of possible syndromes and related diseases.
It depends on the type of tumour. In benign cases, it may consist of image controls, include pharmacological treatments or interventional radiology, and reserving surgery for very specific cases. In malignant tumours, surgery is essential for curing the patient and will be accompanied in general by chemotherapy treatment, which is administered before or after the intervention. In very advanced cases, liver transplants will be necessary.
Blood tests with tumour markers, an abdominal ultrasound and a magnetic resonance imaging scan are normally carried out. In order to plan surgery, it is usually necessary to carry out a CT scan. When there is a suspicion of malignancy, a chest CT will also be done and a small sample of tissue will be taken to know the exact tumour type.
Unfortunately, there are no preventive measures. Unlike liver tumours in adults, closely related to the consumption of alcohol and viral infections (hepatitis), in children they are generally isolated cases. Only a small percentage of cases appear in children with illnesses and syndromes that predispose to their appearance, such as bile ducts atresia or some metabolic diseases, in which it is essential to monitor them so that, if they appear, they can be detected early.
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