Hepatoblastoma

What Is Hepatoblastoma?

Hepatoblastoma is the most common type of liver cancer in children. It most often happens in children under age 3.

What Are the Signs & Symptoms of Hepatoblastoma?

A child with hepatoblastoma (heh-puh-toe-blass-TOE-muh) usually will have a painless mass (a large belly that sticks out).

Less common symptoms include:

• belly pain
• jaundice (yellow skin or eyes)
• dark pee
• back pain
• fever
• itching
• large veins that can be seen in the skin around the belly
• loss of appetite
• weight loss
• nausea and vomiting

What Causes Hepatoblastoma?

Children are more likely to get hepatoblastoma if they:

• are born early with a very low birth weight 
• have a growth disorder called Beckwith-Wiedemann syndrome (which makes the body and internal organs grow too much or get too big)
• have a genetic condition called familial adenomatous polyposis (which causes growths in the lining of the intestines)
• have a problem with a gene (the APC suppressor gene) that normally keeps tumors from growing

Hepatoblastoma is more common in boys than in girls.

How Is Hepatoblastoma Diagnosed?

When a child has hepatoblastoma symptoms, the doctor will do an exam. Tests done may include:

• blood tests, including liver function tests and an alpha fetoprotein (AFP) test (liver damage and some cancers can raise the level of this protein in the blood)
• imaging tests:
  • ultrasound
  • X-rays
  • CAT scan
  • MRI
• a biopsy: removing a piece of tumor tissue with the help of ultrasound, which lets the doctor see the best area of the tumor to remove

How Is Hepatoblastoma Treated?

Doctors usually treat hepatoblastoma with a combination of surgery and chemotherapy. If possible, children with cancer should go to a medical center specializing in the treatment of pediatric cancers.

Treatment depends on:

• the child's age
• the size of the tumor
• whether there is one or many tumors in the liver
• whether the cancer has spread from the liver

Treatment Options

Surgery is necessary to cure hepatoblastoma. But because of the size of the tumor, it's not possible in most children at the time they're first diagnosed.

Chemotherapy helps shrink the tumor so that doctors can remove it. Sometimes the tumor is so large that a liver transplant is needed because the whole liver must be removed to get the entire tumor.

Radioembolization (or Y90) is a type of therapy that delivers high-dose radiation directly to the liver tumor through the bloodstream. The radiologist inserts a tiny catheter (plastic tube) in the groin and passes it to the artery closest to the tumor. This procedure protects much of the normal liver tissue from the effects of Y90.

Y90 can be used as primary therapy in liver tumors that don't respond well to chemotherapy. It's also used when the tumors come back or don't shrink enough for surgery.

Transarterial chemoembolization (TACE), which sends chemotherapy particles directly to the tumor.

Tumor ablation, which is when doctors destroy tumors by using small needles to heat or cool them.

Who Treats Hepatoblastoma?

Hepatoblastoma is treated by a health care team, including specialists in:

• oncology (cancer)/hematology (blood diseases)
• surgery
• interventional radiology (image-guided minimally invasive procedures)
• gastroenterology (digestive tract) and hepatology (liver)
• pathology (diagnosing diseases by examining body tissues, fluids and organs)
• genetics (genetic counseling and testing)
• radiology (medical imaging)
• nutrition

What Else Should I Know?

If a surgeon removes the cancer completely, a child's outlook is generally good. After treatment, the doctor will do a checkup every year to see if the cancer has come back, but this doesn't happen in most cases.

Having a child being treated for cancer can feel overwhelming for any family. But you're not alone. To find support, talk to your child's doctor or a hospital social worker. Many resources are available to help you get through this difficult time.

You also can find information and support online at:

• National Cancer Institute
• American Childhood Cancer Organization
• American Liver Foundation