Hepatoblastoma: Are you aware of this rare challenge to your little one's liver?

Moms and dads, you always think about your little one's health, don't you? Sometimes, even a small stomach ache or a loss of appetite can make you feel very scared and anxious. Today, we're going to talk about a cancer that can be a bit scary for parents, but fortunately, it's very rare . This is what doctors call hepatoblastoma. Although the name may sound a bit complicated, let's keep it simple.

What is hepatoblastoma? Let's understand it simply.

Simply put, hepatoblastoma is a very rare type of liver cancer . It mostly affects young children between the ages of 1 and 3. Even in a country like the United States, this condition occurs in one or two children out of a million. That means it is very rare. However, if this disease is detected early and the cancerous lump or lumps can be removed surgically, the child can be completely cured . Sometimes, a liver transplant is another treatment option.

Does your little one have any of these symptoms? Be careful!

There are several common symptoms that can be seen in the case of hepatoblastoma. But remember, don't be afraid to assume that it is this disease just because you have these symptoms. These can also be caused by other simple reasons. However, if these things continue, it is best to see a doctor.

• Stomach pain (especially in the middle or upper right side of the stomach).
• An unusual lump in the stomach. Imagine, when you are bathing your baby or changing his clothes, you feel something strange, like a lump, in the stomach.
• Loss of appetite and weight loss (for no apparent reason). The child is not eating as much as before and seems to be losing weight.
• Persistent nausea and vomiting.
• Yellowing of the skin or eyes (jaundice).

Hepatoblastoma is often a slow-growing cancer . Therefore, your child may not show any symptoms until the cancerous tumor is large enough to affect the body. For example, your child may have a stomachache for several days, or may seem to be losing weight. Not all stomachaches are caused by hepatoblastoma. However, if you have any concerns, such as "this is not just a stomachache," don't hesitate to see your child's pediatrician right away.

Why is this happening? What are the reasons?

In fact, experts still don't know exactly how healthy liver cells turn into cancer cells. However, there are some conditions that increase the risk of hepatoblastoma:

• Being born with very low birth weight (birth weight less than 2.4 kilograms).
• Premature birth (birth before 37 weeks).
• Aicardi syndrome: This can cause malformations in the baby's brain and other parts of the body.
• Beckwith-Wiedemann syndrome: This can affect a child's development and increase the risk of cancer.
• Biliary atresia: This can block the bile ducts in young children and cause liver damage.
• Edwards syndrome (trisomy 18): This affects the way a child's body develops.
• Familial adenomatous polyposis (FAP): This causes a large number of small growths (polyps) in the colon that can become cancerous.
• Hemihyperplasia: In this, one side of the child's body grows faster than the other.
• Simpson-Golabi-Behmel syndrome (SGB): This can cause abnormalities in the liver and other organs in children.

Not all children with these conditions will develop hepatoblastoma. Also, a child without any of these risk factors can develop this condition. That is why it is said that the exact cause is not known.

Let's also learn about the complications (late effects) that may occur after treatment.

Cancer treatments for hepatoblastoma can sometimes cause late effects . These are health problems that appear months or even years after diagnosis or treatment. Your child may need long-term follow-up and medical care to manage these.

Second cancers are another example of such a late effect. That is, the development of a new type of cancer months or years after completing treatment for hepatoblastoma.

These late effects can affect your child's:

• The ability to think, learn, and remember.
• Growth and development.
• Moods, emotions and mental health.
• Internal organs and tissues.

Don't be afraid of this. Doctors are aware of this too, so they pay attention to things like this.

How do doctors accurately diagnose this disease?

When you take your child to a pediatrician, they will first do a physical examination . They will ask you about your child's symptoms and how long they have been present. Then, they may do some tests, such as:

• Alpha-fetoprotein (AFP) tests: AFP is a substance produced by the baby's liver. Its levels are checked.
• Complete blood count (CBC): This measures the types and amounts of blood cells in the child's blood.
• Comprehensive metabolic panel (CMP): This tests 14 different substances in the child's blood and liver function.
• Liver and Doppler ultrasounds: These allow doctors to take pictures of the inside of your baby's liver.
• Magnetic resonance imaging (MRI): This test can produce very clear pictures of organs and blood vessels.
• Vascular ultrasound: This test is done to look at the network of blood vessels entering and leaving the child's liver.

Your pediatrician, if necessary, can refer you to a pediatric oncologist, a doctor who specializes in treating cancer in young children.

How are the stages of cancer determined?

Determining the stage of cancer is very important for oncologists to plan treatment. Pediatric oncologists use two classification systems instead of staging cancer. They are:

• PRETEXT: This stands for "pre-treatment extent of disease." Before chemotherapy, which is given before surgery, the doctor looks at how far the cancer has spread to the child's liver. The number of cancer nodules, their size, and their nature are checked.
• POSTTEXT: This stands for "post-treatment extent of disease." It looks at the condition after treatment before surgery.

Our liver has two main parts (lobes). Cancer specialists divide these two parts into four more categories. Each category is classified according to the number of lobes of the liver that contain cancerous tumors. As the number of lobes with cancerous tumors increases, the number of categories also increases.

For example, consider this: Tests find two cancerous lumps in two different parts of a child's liver. The cancer is then classified as PRETEXT stage II. If chemotherapy removes one lump before surgery, the cancer is classified as POSTTEXT stage I. The doctor then says that the child now has stage I hepatoblastoma.

Other types of hepatoblastoma are:

• Category I: The cancer is in only one part of the child's liver. The other three parts are not affected.
• Category II: There are two cases of this. One is that cancer is present in two adjacent parts of the liver, but not in the other two parts. The other is that cancer is present in one part, but not in two non-adjacent parts.
• Stage III: Cancer is present in one or more parts of the liver, but there is no cancer in the parts directly adjacent to the parts with cancer.
• Category IV:The cancer has spread to all four parts of the child's liver.

Although these classifications may seem a bit complicated, the doctors will explain them to you thoroughly.

What are the treatments available?

The most common treatment is surgery to remove the part of the liver that is affected by the cancer . The liver is one of the most amazing organs in our body. Because it is the only organ that can regrow after a part is surgically removed. This means that your child's liver will eventually grow back to its original size.

Your child's pediatric oncologist may decide to give you more chemotherapy before and after surgery. This treatment is used to shrink the cancerous tumor.

The child may receive chemotherapy for about four to six weeks after surgery. This chemotherapy, given after surgery, reduces the chance of the cancer coming back.

Other hepatoblastoma treatments include:

• Ablation therapy: This is a minimally invasive procedure for recurrent hepatoblastoma.
• Liver transplant: This is an option if the cancer has affected the central part of the liver or multiple parts of the liver.
• Transarterial chemoembolization (TACE): This procedure involves cutting off the blood supply to the cancerous tumor and delivering chemotherapy drugs directly to the tumor.

Can hepatoblastoma be cured?

Yes, it can. But it depends on when your child is diagnosed and how long they receive treatment. Hepatoblastoma can be cured if your child's surgeon can remove all or part of the cancerous lump .

"Early detection and prompt treatment are two very important factors in the fight against this disease."

What are the survival rates?

Cancer survival rates are only estimates based on the experiences of people with different types of cancer. Overall, 4 out of 5 children with hepatoblastoma survive five years after diagnosis .

When thinking about recovery rates, it's important to remember that your child's experience may be different from other children's .

There are many factors that can affect the prognosis of hepatoblastoma. If you have questions about survival rates, your child's pediatric oncologist is the best source of information. He or she can explain what these figures mean in your child's case.

When should my child see a doctor?

Your child should have regular follow-up appointments with the cancer care team. The team will regularly check your child's health, including any late effects. They will also check for signs of hepatoblastoma coming back or new cancer.

When should I take my child to the Emergency Room?

Hepatoblastoma treatment usually involves surgery. Surgery can cause complications, such as infection. Take your child to the emergency room immediately if any of the following occur:

• If the fever is higher than 100.4 degrees Fahrenheit (38.3 degrees Celsius).
• If the surgical site is dark red, or if the child is in pain when you touch it.
• If a green or yellow fluid oozes from the surgical site.

How can you help your child with these tests and treatments?

Tests are essential to find out why your child is sick. But needles to draw blood can hurt. Children can be scared by the noise of MRI machines. Children can feel anxious and scared about chemotherapy or surgery. It is very common for a child to react this way when they have cancer. Working with a child life specialist at this time can be a great help for your child (and you) as they go through these tests and treatments.

When you find out that your child has hepatoblastoma, you may be overwhelmed by a multitude of emotions. While you may be trying to stay calm on the outside, you may feel like you are falling apart on the inside. This is a very difficult time. Although hepatoblastoma can be cured with treatment, dealing with the treatment can be a challenge for both the child and their loved ones.

Your child's surgeon and the rest of the care team understand these challenges. They will do everything they can to make the treatment as easy as possible. They will also be happy to explain what you can expect and how you can help your child. Remember that you are not alone.

Finally, the most important things to remember (Take-Home Message)

• Hepatoblastoma is a very rare liver cancer that mainly affects young children between the ages of 1-3 years.
• Be aware of symptoms like stomach pain, bloating, loss of appetite, weight loss, persistent vomiting, and jaundice. Don't panic just because you have these, but see a doctor.
• This disease is more curable with early detection and prompt treatment .
• Treatment options include surgery, chemotherapy, and liver transplant.
• Late effects can occur after treatment, so long-term follow-up is important.
• Maintain good communication with your child's doctor. Ask all your questions and concerns.
• Get mental and emotional support for yourself and your child during this journey.

I hope this information helps you gain some understanding of this rare condition. I wish your child a speedy recovery!

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