Hepatoblastoma in Children
Hepatoblastoma is a very rare cancer that starts in the liver. It
usually affects children less than 3 years of age. About half of all children with
are diagnosed before age 1. It usually doesn’t spread (metastasize) to other parts
The cancer is caused by gene changes in liver cells. The reason why
this happens is not known.
Some genetic health conditions
increase a child's risk. These include:
- Beckwith-Wiedemann syndrome
- Familial adenomatous polyposis
- Glycogen storage diseases
- Aicardi syndrome
Babies born at a very low birth
weight also seem to be at higher risk.
Symptoms depend on the size of the
tumor. They tend to be different in each child. They can include:
- Lump (mass) in the belly
- A swollen abdomen
- Pain in the abdomen
- Loss of appetite
- Weight loss
- Feeling tired
- Nausea and vomiting
- Yellow color to the skin or whites of
the eyes (jaundice)
- Itchy skin
The symptoms of hepatoblastoma are
a lot like those of many other health conditions. Still, it's important to take your
child to see a healthcare provider if you notice these symptoms. Only a healthcare
provider can tell if your child has cancer.
You may take your child to a
healthcare provider because of a lump, swelling, pain in the belly (abdomen), or other
symptoms. The healthcare provider will ask about your child's symptoms. A physical
focusing on the abdomen, will be done. Your child may need to see a pediatric
oncologist. This is a doctor with special training in diagnosing and treating cancer
children. Your child may need tests such as:
Blood tests. These tests
look for signs of illness. They check for blood clotting problems, liver and kidney
function, tumor markers, gene problems, and more.
Sound waves are used to create images of the inside of your child's
abdomen. This is often one of the first tests used to look at the liver.
CT scan. A series of
X-rays and a computer are used to make images of the inside of the body. This may
done to look at blood vessels in the liver.
MRI. Large magnets,
radio waves, and a computer are used to make detailed images of the inside of the
body. This may also be done to look at blood vessels in the liver.
Tumor biopsy. A tiny
piece (called a sample) of the tumor can be taken and checked for cancer cells. A
biopsy is needed to diagnose hepatoblastoma. It may be done with a needle or during
After a diagnosis of
hepatoblastoma, your child will need more tests. These help your child's healthcare
providers learn more about the cancer. They'll show how big the tumor is and how far
cancer has spread inside your child's liver. Two groupings are then assigned:
- The PRETEXT group is assigned at the
time of diagnosis. It describes the tumor before treatment starts.
- The POSTTEXT group describes the tumor
Both groupings use Roman numerals
and can have a value of I (1), II (2), III (3), or IV (4). The higher the number,
more parts (lobes) of the liver involved and the more advanced the cancer is.
These groupings are important to
know when deciding how to treat the cancer. Be sure to ask your healthcare provider
explain your child's PRETEXT and POSTTEXT groupings in a way you can understand.
Talk with your child's healthcare
team about your child's treatment options, the goals of treatment, and what the risks
and side effects may be.
Treatment will depend on the
PRETEXT group and other factors. Hepatoblastoma can be treated with any of these:
Surgery. This may be
done to take a sample of the tumor for diagnosis. It's also done to remove as much
the tumor as possible (resection). Surgery can be used to remove tumors in other
parts of the body, like the lungs.
Chemotherapy. These are
strong medicines that kill cancer cells. They may be given before or after surgery.
They are given right into the blood through a vein (IV), as a shot (injection), or
mouth (oral). The medicines may also be put right into the liver. This is done with
tube (catheter) that goes into the liver's main artery. This is called
chemoembolization of hepatic artery. The chemo is mixed with a substance that blocks
the flow of blood to the tumor. This keeps the tumor from growing and spreading.
Liver transplant. If a
tumor can’t be removed, the entire liver may be removed and replaced with a liver
from a donor.
Radiation therapy. These
are high-energy X-rays or other types of radiation. Radiation is used to kill cancer
cells or stop them from growing. It isn't often used to treat hepatoblastoma. But
radioembolization might be an option in some cases. To do this, tiny radioactive
beads are put into the main artery in the liver that goes to the tumor. The beads
collect there and the radiation kills nearby cancer cells.
Clinical trials. Most
children with cancer are treated as part of a clinical trial. Taking part in a
clinical trial means your child gets the best treatment available today, and might
also get new treatments that are thought to be even better. Before starting
treatment, ask your child's healthcare provider if there are any treatments being
tested that may work well for your child.
Treatment can cause side effects. Medicines and other treatments can
be used for pain, fever, infection, and nausea and vomiting.
Your child may have just one treatment or a combination of
treatments. Tests will be done during treatment to see how well it's working.
With any cancer, how well a child
is expected to recover (prognosis) varies. Keep in mind:
- Getting medical treatment right away
is important for the best outcomes. Cancer that has spread is harder to treat.
- Ongoing follow-up care during
and after treatment is needed.
- New treatments are being tested to
improve outcomes and lessen side effects.
Complications can be caused by the
tumor or treatment, such as:
- Infections and bleeding from
- Increased infections, bruising and
bleeding, vomiting, diarrhea, hair loss, and tiredness with some chemotherapy
- Problems with growth and
- Heart, kidney, or lung problems
- Problems with liver function
- Spreading cancer (metastasis)
- Cancer that grows back
- Growth of new cancers later in
- Rejection of the new liver and/or
problems with anti-rejection medicines if a liver transplant is needed
A child with a hepatoblastoma needs
ongoing care. Your child will be seen by oncologists and other healthcare providers
treat any late effects of treatment and to watch for signs or symptoms of the tumor
returning. Your child will be checked with imaging tests and other tests. And your
may see other healthcare providers for problems from the tumor or from treatment.
You can help your child manage
cancer treatment in many ways. For instance:
- Your child may have trouble eating. A
dietitian may be able to help.
- Your child may be very tired. They
will need to balance rest and activity. Encourage your child to get some exercise.
This is good for overall health. And it may help to lessen tiredness.
- Get emotional support for your child.
Find a counselor or child support group can help.
- Make sure your child attends all
When to Call a Healthcare Provider
Your child's healthcare provider
will talk with you about when to call. You may be told to call if your child has:
- Signs of infection, such as fever of
100.4°F (38.0°C) or higher, or as directed by your child's healthcare provider
- Symptoms that get worse
- New symptoms
- Side effects from treatment that
affect their daily function or don't get better with treatment
Ask your child's healthcare provider what signs to watch for and when
to call. Know how to get help after office hours and on weekends and holidays.
- Hepatoblastoma is a very rare
cancer (malignancy) that starts in the liver.
- Symptoms include a lump (mass),
swelling, and pain in the belly (abdomen).
- Diagnosis is done with blood tests,
imaging scans, and biopsy.
- It may be treated with surgery,
chemotherapy, and other methods.
- Follow-up care is needed to watch for
complications and cancer that comes back.
Tips to help you get the most from
a visit to your child’s healthcare provider:
- Know the reason for the visit and what
you want to happen.
- Before your visit, write down
questions you want answered.
- At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
instructions the provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
- Ask if your child’s condition can be
treated in other ways.
- Know why a test or procedure is
recommended and what the results could mean.
- Know what to expect if your child does
not take the medicine or have the test or procedure.
- If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.