Cancer of the liver in children: Hepatoblastoma
It is a malignant (cancerous) tumor of the liver which occurs in young children. This is a different type cancer than the adult type of liver cancer (hepatocellular cancer or HCC). The true incidence of this tumor in Pakistan is unknown. The average age at diagnosis is one year and most cases occur before two years of age. Hepatoblastoma is not associated with previous hepatitis, unlike hepatocellular carcinoma. Usually there are no associated genetic factors. There may be an increased risk of hepatoblastoma in children who have a family history of familial polyposis coli, or if the child has a condition called Beckwith-Wiedemann syndrome.
We will need to carry out some tests to find out as much as possible about the type, position and size of the tumor. This will help us to decide on the best treatment for your child. The tests will include:
- Blood samples – hepatoblastoma usually produces a protein called alpha-fetoprotein (AFP) which is released into the bloodstream. This is usually referred to as a tumor marker and is used to monitor response to treatment
- Chest X-ray – this will tell us if the tumor has spread to the lungs
- Ultrasound scan – this will tell us the position and size of the tumor. We can also use ultrasound scans to monitor the response to treatment
- CT scan or MRI scan – an MRI or CT scan of your child’s abdomen and CT scan of the lungs will be carried out. This will give us more detailed information about the tumor and may tell us if it has spread
- Biopsy – this is usually carried out under general anaesthetic under ultrasound guidance. The radiologist will take a small piece of tissue from the lump with a small needle. The biopsy will help us to make a diagnosis
Staging is a measure of how far the tumor has spread beyond its original site. For treatment purposes, there are two groups. These are ‘standard risk’ and ‘high risk’ as follows:
- Standard risk is when the tumor is confined to the liver and involves at most three segments of the liver
- High risk is when the tumor involves all four segments of the liver and/or the tumor has spread outside of the liver
Treatment of hepatoblastoma
Treatment for hepatoblastoma depends on which risk group your child falls into. The treatment usually includes chemotherapy and surgery, and occasionally liver transplantation.
Surgery is carried out following chemotherapy to shrink the tumor. The aim is to remove the tumor completely and this is undertaken by a specialist liver surgeon. If it is not possible to remove the tumor completely after further chemotherapy, then liver transplantation maybe considered.
Treatment with anti-cancer drugs is used to destroy the cancer cells. It is usually given by injections and drips into a vein (intravenous infusions). The type of chemotherapy will vary in intensity and duration according to the risk group of the tumor.