Hepatoblastoma in Children: Symptoms, Diagnosis and Treatments

What is it? It is a liver cancer and a very rare condition in children.

It is estimated that 0.9 per 1 million children suffer from this condition, according to St. Jude Children’s Hospital. Hepatoblastoma is diagnosed more frequently in children from infancy to approximately 3 years of age.

Many cases of hepatoblastoma were first observed as an abdominal mass that parents or a doctor discover while bathing or examining the child.

Signs and symptoms

Hepatoblastoma usually presents as a knot in the stomach. Other symptoms include:

  • Little appetite
  • Weightloss.
  • Lethargy.
  • Fever.
  • Vomiting
  • Jaundice.

Diagnosis of Hepatoblastoma

You need to perform some tests to find out as much as possible about the type, position and size of the tumor.

This will help to decide on the best treatment for the child. The tests will include:

Blood sample – hepatoblastoma often produces a protein called alpha-fetoprotein (AFP) that is released into the bloodstream.

This is generally referred to as a tumor marker and is used to control the response to treatment.

Chest x-ray – this is to discover if the tumor has spread to the lungs.

Ultrasound – will indicate the position and size of the tumor. Ultrasound may also be used to monitor the response to treatment.

Computed tomography or MRI scan – an MRI or CT scan of the abdomen and exploration of the child’s lungs will be done.

This will give more detailed information about the tumor and can show if it has spread.

Biopsy – this is a small operation, usually carried out under general anesthesia. The surgeon will remove a small piece of tumor tissue, which will help get a specific diagnosis.

Standards

Staging is a measure of the extent to which the tumor has spread beyond its original site. For treatment purposes, there are two groups. These are “standard risk” and “high risk”:

Standard risk – is when the tumor is confined to the liver and has infected most of the three segments of the liver.

High risk – is when the tumor affects all four segments of the liver and / or the tumor has spread outside the liver.

Treatment of hepatoblastoma

Surgery

The surgery is carried out after the chemotherapy to reduce the tumor. The goal is to eliminate the tumor completely and this is carried out by a liver specialist surgeon.

If it is not possible to remove the tumor completely after chemotherapy is applied, it is possible that liver transplantation is considered.

Chemotherapy

Treatment with cancer drugs is used to destroy cancer cells. It is usually given by injections and drips into a vein (intravenously).

The type of chemotherapy can vary in intensity and duration according to the risk group of the tumor.

If the child participates in a clinical trial, the treatment is explained in more detail in the data sheet of the specific trial. An outline of the treatment will be given in the form of a ‘road map’.

Clinical trials

Clinical trials are studies of medical research in patients that are carried out to try to find new and better treatments.

In cancer, clinical trials are most commonly used to try to improve different forms of treatment such as surgery, radiotherapy or chemotherapy.

The treatment that is being tested can be directed to:

Improve the number of people cured (for example, trying new types of surgery or chemotherapy).

  • Improve survival
  • Alleviate the symptoms of cancer.
  • Relieve the side effects of treatment.
  • Improve the quality of life or the sense of well-being of people with cancer.

Clinical trials may also involve research aimed at understanding more about the biology of the tumor.

You may be asked to allow us to do research on the tumor sample removed during surgery, or on blood samples.

General side effects of chemotherapy

Bone marrow suppression (myelosuppression)

Chemotherapy drugs decrease the production of blood cells by the bone marrow for a variable period of time.

This results in a low level of red blood cells (anemia), low white blood cells (neutropenia) and platelets (thrombocytopenia).

The child may need blood transfusions or platelets and will be at a higher risk of getting infections.

Nausea and vomiting

Some of the chemotherapy drugs used can make the child feel sick or vomit.

Also, the doctor will prescribe medication to stop nausea and vomiting. These are generally very effective.

Mouth pain (mucositis)

Some of the chemotherapy drugs cause the lining of the mouth and throat to ulcerate and cause pain.

Hair loss

Long-term effects of treatment

A small number of children can develop side effects many years later because of the treatment they have received.

These may include hearing problems, heart problems and kidney function and a small risk of developing a second hepatoblastoma later in life.