What is hepatoblastoma and hepatocellular carcinoma?

Hepatoblastoma and hepatocellular carcinomas are types of cancers that occur in the liver. The liver is an organ in the upper right side of the abdomen, protected by the rib cage. Its function is to store and filter blood, aid in digestion and clear waste products in the body.

Liver tumors are rare in childhood and account for about 1.5 percent of all pediatric cancers. It appears to occur at the same rate in both males and females. Hepatoblastoma usually occurs in children under three years of age, and is rare after five years of age, while hepatocarcinoma is usually seen in older children and teens. Hepatocellular carcinoma can occur in livers damaged by serious disease or infection such as hepatitis B or C which are viral infections of the liver. It is not contagious and nothing you have done or not done is responsible for your child’s tumor.

What are the symptoms of hepatoblastoma and hepatocellular carcinoma?

The most common symptoms include swelling in the upper abdomen, pain, weight loss, vomiting, and occasionally jaundice or yellowing of the skin.

How are hepatoblastoma and hepatocellular carcinoma diagnosed?

The only way to diagnose and differentiate tumors of the liver is to obtain a piece of the tumor and examine it under the microscope. This surgical procedure is called a liver biopsy. Both types of liver tumors have the ability to spread, or metastasize, to other parts of the body including the lungs, lymph nodes, and central nervous system. In order to determine the extent of the tumor and if it has spread, your child will undergo various diagnostic tests. This may include any or all of the following:

• Surgical biopsy. This is the most accurate way of diagnosing and is done for all liver tumors. A surgeon removes samples of the tumor and surrounding tissue and the pathologist examines the specimens. A pathologist is a doctor who tests tissue for disease using a microscope and other biology tests. Examining cells under the microscope will confirm the cancer diagnosis and shows if it has spread outside of the liver. Often, the slides of tumor tissue are sent to a central reference laboratory for further confirmation. A central reference lab has equipment and personnel specialized in diagnosis of cancer and other illnesses. A specimen collected at the time of diagnosis can be sent to a central reference lab and compared to a known specimen to verify diagnosis of a suspected condition.
• X-rays. X-rays of the tumor site and surrounding area look at size and extent of the tumor. X-rays of the chest look for spread of the tumor in the chest area.
• Bone marrow aspirate and biopsy. This is usually done at the time of diagnosis to determine if the tumor has invaded the bone marrow.
• Computed tomography (CT) scan. This test produces images of the scanned body part and is used to see the size of the tumor and whether it has spread.
• Magnetic resonance imaging (MRI). A computerized magnetic scan of body tissues can help determine the extent of the tumor.
• Bone scan. A dye is injected via an intravenous (IV) line and scans are taken to detect tumor in bones.
• Ultrasound. Sound waves are used to look at the extent of tumor in the liver.
• Blood tests. Blood tests may include alpha-fetoprotein (a tumor marker which is usually elevated in liver tumors), blood chemistries and enzymes, and a complete blood count.

After the tests are completed and the diagnosis has been made, a group of doctors including oncologists, radiologists, pathologists, and surgeons discuss and determine your child’s condition, what stage the disease is in, and the most effective treatment for your child. The staging system used by your physicians is as follows:

• Stage I. The tumor has been completely removed.
• Stage II. The tumor has been resected but microscopic parts remain. There is no lymph node involvement. There is no “spilled” tumor.
• Stage III. The tumor is not completely removed or the tumor is resected but there is lymph node involvement or tumor spill.
• Stage IV. The tumor has spread (metastasized) to other organs of the body.

How are hepatoblastoma and hepatocellular carcinoma treated?

The treatment for liver tumors usually includes aggressive surgery to remove the tumor. It is possible to remove 85 percent of the liver and it will regenerate. Unfortunately, complete resection of the tumor is often not possible due to the extent and location of the tumor. Chemotherapy may be used to shrink the tumor for future surgical removal. Generally, most of your child’s chemotherapy will be given as an inpatient. A treatment plan will be mapped out and explained to you in detail. During and after treatment, various follow-up studies such as CT scans and blood tests will be done to closely monitor your child’s disease status.

About treatment for hepatoblastoma and hepatocellular carcinoma at Children’s

Children’s cancer and blood disorders program consistently achieves treatment results ranking it as one of the top 10 programs in the U.S. Children’s treats the majority of children with cancer and blood disorders in Minnesota and provides patients with access to a variety of clinical trials and new treatments. Through our renowned solid tumors program, patients experience unparalleled family support, a nationally renowned pain management team, and compassionate, coordinated care.

Contact Us

If you are a family member looking for a Children’s hematologist or oncologist or wanting to schedule an appointment, please call our clinic at Children’s – Minneapolis at 612-813-5940.

If you are a health professional looking for consultation or referral information, please call Children’s Physician Access at 1-866-755-2121 (toll-free) and ask for the on-call hematologist/oncologist.