OVERVIEW
A malignant embryonic tumor of embryonic liver tissue with multiple differentiation potential.
It often presents with bulging abdomen, right upper abdominal mass, loss of appetite, anorexia and weight loss.
Surgical resection of the tumor is the first and most effective treatment, often supplemented by chemotherapy.
The prognosis is relatively good after the disease is controlled by active treatment, but the prognosis is poor if the tumor recurs.
Definition
Hepatoblastoma (HB) is the most common primary malignant tumor of the liver in childhood.
The tumor is embryonal and contains epithelial and mesenchymal components.
In general, the symptoms are less specific at the onset of the disease, and the disease progresses more rapidly than that of malignant tumors, resulting in a larger tumor by the time the child is seen.
Whether or not the tumor can be completely removed is an important factor affecting the survival time of the child after treatment, and currently the most effective clinical treatment is surgical resection.
Classification
Histologic classification
According to histologic classification, the tumor can be divided into complete epithelial type and mixed epithelial and mesenchymal type. Different types will affect the staging, treatment and prognosis of the tumor.
Complete epithelial type
Fetal type, which is the more common type, accounts for about 1/3 of the cases, and has a good prognosis due to the relatively high degree of differentiation of cells in this type.
Other types are relatively less differentiated, including embryonic type, small cell undifferentiated type, giant trabecular type, and cholangioblast type.
Mixed epithelial type
Mixed epithelial mesenchymal type with teratoma features.
Intermixed epithelial mesenchymal type without teratoma features.
Pathogenesis
Hepatoblastoma is a rare malignant tumor with an incidence of 1/1.5 million to 1/1 million.
The age of onset is mostly within 3 years, accounting for about 80% of cases. Of these, 60% occur within 1 year of age, and the prevalence is higher in boys than in girls.
Older children and adults may occasionally develop the disease [1-2].
Causes
Causes
The exact cause of hepatoblastoma is not known and most cases are disseminated, i.e., there is no other member of the family with the disease.
Risk factors
The following factors may increase the risk of hepatoblastoma and are called high risk factors [3-5].
Abnormalities in the child
Such as low birth weight, preterm birth, etc.
Concomitant with certain hereditary tumors or congenital disorders
such as Beckwith-Wiedemann syndrome, Sotos syndrome, familial adenomatous polyposis, etc.
Abnormalities in the mother’s pregnancy
Associated occupational exposures, such as prolonged exposure to certain chemical products.
History of smoking in the mother, or high blood pressure during pregnancy, obesity in early pregnancy.
Excessive amniotic fluid, pre-eclampsia.
Pathogenesis
Hepatoblastoma is a complex, multifactorial, multistep pathologic process, and its specific pathogenesis has not been fully elucidated.
Genetic and molecular biological studies have revealed that the acquisition and deletion of some chromosomes as well as alterations in signaling pathways can affect cell growth, apoptosis, signal transduction and differentiation.
Two of the most frequently involved signaling pathways are the Wnt/β-catenin and insulin growth factor signaling pathways.Abnormalities in the Wnt/β-catenin signaling pathway are a major cause of hepatoblastoma development, and approximately 70% of sporadic hepatoblastomas have accumulation of β-catenin [4].
Questions you may be concerned about
What causes hepatoblastoma?
The cause of hepatoblastoma is not clear at the moment, but the appearance of the disease may be related to factors such as paraphyseal hypertrophy, familial adenomatous colonic polyps, and Bevie’s syndrome.
1. Eccentric hypertrophy: the occurrence of eccentric hypertrophy will lead to the overgrowth of one side of the patient’s body, and the risk of hepatoblastoma will be higher for the patients who are affected by this kind of disease.
2. Familial adenomatous polyposis: Familial adenomatous polyposis, an autosomal dominant disease, is associated with the risk of hepatoblastoma.
3. Behçet-Weil syndrome: Behçet-Weil syndrome is an inherited syndrome caused by loss of alleles, which leads to an increased risk of many malignant diseases.
Since the exact cause of hepatoblastoma is unknown, prevention of the disease is relatively difficult. If the diagnosis of hepatoblastoma is confirmed through examination, it is important to operate as early as possible when surgery is possible without delay.
Symptoms
Main Symptoms
Bulging abdomen
When the child is lying down, the anterior abdominal wall is significantly higher than the plane between the edge of the rib cage and the pubic symphysis of the perineum, with a bulging appearance, which is called abdominal bulge. Abdominal bulging is the more common symptom of hepatoblastoma.
Because of the lack of specificity of the symptoms and the large amount of abdominal fat in infancy, parents often mistake it for normal obesity and ignore it.
Right upper abdomen mass
Hepatoblastoma patient’s liver may keep enlarging, and there is a mass in the right upper abdomen, which is hard in texture and irregular in shape.
It may be accompanied by different degrees of pressure pain, i.e. no pain when not touched, but pain when pressed.
The vast majority of patients seek medical attention for this reason.
Loss of appetite and anorexia
Loss of appetite, anorexia and resulting weight loss are common accompanying symptoms.
Other symptoms
Digestive tract symptoms
Symptoms such as nausea and vomiting are easily overlooked due to lack of specificity.
Systemic symptoms
Such as abdominal pain, abdominal distension, dysphoria, fever, malaise, lethargy, anemia, weight loss or slowed weight gain, ascites, jaundice, and so on. In the advanced stage, cachexia, i.e., severe emaciation of the body, anemia, anorexia, and generalized debility, may occur.
Difficulty in breathing
In advanced stage, if the abdominal tumor is huge, it may cause breathing difficulty.
Consultation
Department of Medicine
Pediatrics
When an abnormal bulging of the abdomen or a mass in the right upper abdomen is noticed, a visit to the Department of Pediatrics or Pediatric Surgery should be made.
Medical Oncology
When a patient is diagnosed with hepatoblastoma and requires chemotherapy and other internal medicine-related treatments, he or she may choose to consult the Department of Medical Oncology.
Preparation for medical treatment
Consultation: Registration, Preparation of Documents, Frequently Asked Questions
Tips for Medical Treatment: Registration, Preparation of Documents, Frequently Asked Questions
X-ray, CT or MRI examination may be required during the consultation. Avoid wearing metallic clothing such as shirts with buttons, blouses with sequins, and dresses with zippers and buttons.
Record the symptoms, duration and other relevant information to give your doctor more information.
Preparation Checklist for Doctor’s Visit
Symptom Checklist
In particular, you should pay attention to the time of occurrence of the symptoms, special manifestations, etc.
Has the child’s abdomen been found to be bulging and for how long?
Is there any lump when touching the abdomen, and since when was it noticed?
Does your child seem to have a loss of appetite, anorexia, weight loss or weight gain recently?
Does the child usually have nausea, vomiting, fever, or poor mental health?
Medical History Checklist
Was the patient born with low birth weight or preterm?
Is there a history of Beckwith-Wiedemann syndrome, Sotos syndrome, familial adenomatous polyposis, etc.?
Was there prolonged exposure to certain chemicals during pregnancy?
Is there a history of high blood pressure, excessive amniotic fluid, pre-eclampsia, or early pregnancy obesity during pregnancy?
Does the mother have a history of smoking?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Laboratory tests: routine blood tests, renal function, iontometry, lipids, blood glucose, coagulation function.
Imaging tests: abdominal ultrasound, CT, magnetic resonance imaging (MRI), PET-CT.
Specialized tests: alpha-fetoprotein (AFP), liver function tests, histopathological biopsy.
Diagnosis
Diagnosis is based on
Medical history
Patient.
The patient may have a history of the following:
Low birth weight or preterm labor.
History of Beckwith-Wiedemann syndrome, Sotos syndrome, familial adenomatous polyps.
Patient’s mother
The patient’s mother may have the following conditions:
Chronic exposure to certain chemicals.
History of hypertension during pregnancy, excessive amniotic fluid, pre-eclampsia, obesity during early pregnancy.
Chronic smoking.
Clinical manifestations
There may be abdominal bulging, right upper abdominal mass, loss of appetite, anorexia, weight loss or slowed rate of weight gain.
Laboratory Tests
Tumor Markers
Serum alpha-fetoprotein (AFP) is a common and important indicator for early diagnosis and outcome monitoring.
More than 90% of children with hepatoblastoma have elevated serum alpha-fetoprotein, and the level of alpha-fetoprotein is often tens or even thousands of times higher in children with progressive stage, which can be reduced to normal after complete resection of the tumor, and then elevated again after recurrence or systemic metastasis.
Note: Normal newborns have a high serum alpha-fetoprotein level, which gradually decreases to the normal level. Therefore, infants with elevated alpha-fetoprotein should be monitored dynamically.
Liver function tests
Commonly used indicators are:
Glutamate aminotransferase (ALT), Mentholatum aminotransferase (AST), reflecting the degree of liver cell destruction.
Bilirubin, reflecting the secretion and excretion function of the liver.
Albumin, preprotein and prothrombin time, reflecting the synthesizing function of the liver.
Imaging
Ultrasonography
Ultrasonography is the most commonly used method of liver imaging, with the advantages of simplicity, real-time, non-invasive and sensitive, and can be the preferred examination.
It can determine the location and size of the tumor in the liver, and the proximity of the tumor to important blood vessels such as the hepatic portal vessels and the inferior vena cava, assisting in the diagnosis and deciding the relevant treatment plan.
Ultrasound reveals inhomogeneous enhancement sonograms within the liver, mostly isolated foci, most of which are solid space-occupying lesions, with occasional cystic areas or punctate irregular calcifications.
CT examination
CT can better show the size of the tumor and its relationship with the surrounding tissues, especially can observe whether there is any invasion of the blood vessels in the liver portal, which provides an intuitive reference basis for surgery.
CT mostly shows a single rounded or lobulated mass with a peripheral membrane, which is a low-density occupying lesion after enhancement, and the intrahepatic blood vessels and inferior vena cava may be displaced due to the compression.
Magnetic resonance imaging (MRI)
MRI of liver has the advantages of no radiation, high tissue resolution, etc. It is the preferred imaging technology for clinical detection, diagnosis, and staging efficacy evaluation of hepatoblastoma.
PET-CT
PET-CT can show tumor activity and is mainly used for differential diagnosis of liver tumors and diagnosis of suspected recurrent lesions.
Pathologic examination
Pathological examination is to perform relevant operations on biopsy or surgically resected tissue specimens of liver occupying foci or extrahepatic metastases, and make pathological sections by pathohistological methods, and further examine the lesions with microscope to clarify the nature of the lesions.
Pathologic diagnosis can be obtained through liver puncture biopsy for intrahepatic space-occupying lesions lacking typical imaging features, which is very important for confirming the diagnosis of hepatoblastoma, guiding the treatment and judging the prognosis.
Immunohistochemistry: at least markers such as Glypian-3, HepPar1, β-catenin, AFP, etc., detection of CK7, CK19, CD34, Ki-67 can help to indicate whether the tumor is differentiated to cholangiocytes or not, and to clarify the number of hepatocyte cords between hepatic sinusoids and the proliferation index of the tumor cells.
Staging
Clinical staging
PRETEXT/POST-TEXT staging
This staging system refers to pre-treatment staging (PRETEXT) and pre-surgical staging after chemotherapy (POST-TEXT) [7].
PRETEXT refers only to the extent of pre-treatment tumor involvement in the liver and is mainly used to assess the feasibility of complete surgical resection at the primary diagnosis.
The staging of POST-TEXT is based on the extent of liver tumor involvement after neoadjuvant chemotherapy and is mainly used to assess the feasibility of deferred complete surgical resection.
Stages are defined as follows:
PRETEXT/POST-TEXT I: The tumor was confined to one liver region with no tumor invasion in the other 3 adjacent liver regions.
PRETEXT/POST-TEXT Ⅱ: Tumor invades one or two hepatic regions with no tumor invasion in the other two adjacent hepatic regions.
PRETEXT/POST-TEXT Ⅲ: two or three hepatic regions are invaded by the tumor and another adjacent hepatic region is not.
PRETEXT/POST-TEXT IV: Tumor invades all 4 liver zones.
Modified Children’s Oncology Collaborative Group (COG) Evans staging system
Staging is based on the extent of the tumor and the possibility of complete surgical resection.
Stage I: complete surgical resection.
Stage Ia: the tumor is completely resected and the histopathological type is purely fetal.
Stage Ⅰb: complete resection of the tumor with histopathological type other than simple fetal type.
Stage II: the tumor is basically resected with microscopic residue.
Stage III: mass with microscopic residue; or basic resection with positive lymph nodes; or tumor rupture or intraperitoneal hemorrhage.
Stage IV: distant metastasis at the time of diagnosis, regardless of whether the primary lesion is completely resected.
Clinical risk grouping
Staging PRETEXT Stage I PRETEXT Stage II PRETEXT Stage III PRETEXT Stage IV
Extremely low-risk group M- and VPEFR-, tumor resectable at diagnosis M-, <8 years of age and AFP >100 ng/mL, VPEFR-, tumor resectable at diagnosis None None
Very low risk group
M- and VPEFR-, tumor resectable at diagnosis
M-, <8 years old and AFP >100ng/mL, VPEFR-, tumor resectable at diagnosis
None
None
Low-risk group M- and VPEFR-, tumor not resectable at diagnosis M-, <8 years old and AFP >100ng/mL, VPEFR-, tumor not resectable at diagnosis M-, <8 years old and AFP >1000ng/mL, VPEFR- None
Low-risk group
M- and VPEFR-, tumor unresectable at diagnosis
M-, <8 years and AFP >100ng/mL, VPEFR-, tumor unresectable at diagnosis
M-, <8 years old and AFP >1000ng/mL, VPEFR-
None
Intermediate-risk group M-, VPEFR+ and <8 years of age M-, <8 years of age and AFP >100ng/mL, VPEFR+M-, <8 years of age and AFP 101-1000ng/mL; M-, <8 years of age and AFP >1000ng/mL, VPEFR+M-, <3 years of age and AFP >100ng/mL
Intermediate-risk group
M-, VPEFR+ and <8 years old
M-, <8 years and AFP>100ng/mL, VPEFR+
M-, <8 years and AFP 101-1000ng/mL; M-, <8 years and AFP >1000ng/mL, VPEFR+
M-, <3 years, AFP >100ng/mL
High-risk group M+; M-, VPEFR+ and ≥8 years of age M+; M-, ≥8 years of age; M-, <8 years of age and AFP ≤100ng/mLM+; M-, ≥8 years of age; M-, <8 years of age and AFP ≤100ng/mLM+; M-, ≥3 years of age; M-, <3 years of age and AFP ≤100ng/mL
High-risk group
M+; M-, VPEFR+ and ≥8 years of age
M+;M-, ≥8 years; M-, <8 years and AFP≤100ng/mL
M+;M-, ≥8 years; M-, <8 years and AFP ≤100ng/mL
M+;M-, ≥3 years old; M-, <3 years old and AFP≤100ng/mL
[Notes] M: distant metastasis; V: involvement of 3 hepatic veins and/or inferior vena cava; P: involvement of portal vein bifurcation and/or left and right portal veins; E: involvement of extrahepatic intra-abdominal organs; F: multifocal tumor; R: presence of rupture of the tumor at the time of diagnosis; VPEFR+: presence of 1 or more of the V, P, E, F, and R present.
[Hints] “-” indicates the absence of, e.g., M-, indicating the absence of distant metastases.
Differential diagnosis
Hepatoblastoma should be differentiated from benign liver tumors, hepatic malignant tumors, hepatic hemangioendothelial cell tumors and liver metastases:
Benign tumors of the liver
Similarities: both present with liver occupancy.
Differences: Benign hepatic tumors are mostly negative for markers and have uniform liver density on imaging.
Hepatic malformation tumor
Similarity: Both of them occur in infants and young children, and present with a mass in the right upper abdomen.
Differences: The right upper abdominal mass caused by hepatic malformation tumor is smoother, and the mass is cystic-solid interphase on ultrasound and CT, and serum alpha-fetoprotein is negative.
Hepatic hemangioendothelioma
Similarity: both present with right upper abdominal mass.
Differences: hepatic hemangioendothelioma is often solitary, CT enhancement scan shows obvious peripheral enhancement of the tumor, and alpha-fetoprotein is mostly normal.
Hepatic metastatic tumor
Similarity: both have the manifestation of right upper abdominal mass.
Differences: many malignant tumors can be metastasized to the liver through blood circulation, for example, neuroblastoma can occur in the early stage of infants within 6 months. Measurement of alpha-fetoprotein, serum neuron-specific enolase, and urinary 3-methoxy-4-hydroxy-picrynic acid can be used to differentiate these tumors.
Hepatocellular carcinoma
Similarity: both present with right upper abdominal mass.
Differences: Hepatocellular carcinoma is a malignant tumor of the liver that commonly occurs in adults, often accompanied by cirrhosis and hepatitis B virus (HBV) infection, and consists of tumor cells resembling hepatocytes without mesenchymal component.
Treatment
Treatment objective: to achieve cure in early stage, to maximize the relief of patient’s symptoms in middle and late stage, to improve the quality of life, and to prolong the survival time.
Treatment principle: adopt multidisciplinary participation and coexistence of multiple treatment methods, mainly surgical resection, and choose reasonable treatment methods for children with different conditions of hepatoblastoma so as to maximize the therapeutic effect.
Surgical treatment
Radical resection
Principle of Surgery
The principle of surgical treatment is to radically resect the tumor and ensure the effective compensation of the remaining liver function, so as to increase the survival rate of the children and ensure the quality of life of the children after surgery.
In choosing the surgical method, clinicians should consider the size and location of the tumor, the pathology of the tumor and the physical condition of the child to decide the surgical plan.
Scope of surgical resection
The scope of surgical resection can be selected according to the recommendations of the Children’s Oncology Group (COG) surgical guidelines.
For children with PRETEXT stage I and II, segmental or lobectomy is performed.
For children with POST-TEXT stage II and III without large vessel invasion, hepatic lobectomy or hepatic trilobectomy is performed.
Complex hepatectomy or liver transplantation is indicated for children with POST-TEXT stages III and IV who have large vessel invasion. Complex hepatectomy should be performed by a team of experienced and competent liver transplantation surgeons.
Liver transplantation
Compared with hepatectomy, liver transplantation is more complete in eradicating the lesion, but due to the adverse effects of immunosuppressive therapy and the insufficient number of donors, it has been commonly used as a salvage treatment for end-stage hepatoblastoma.
The indications for liver transplantation given according to the Pediatric Hepatoblastoma Protocol (2019 edition) are:
Liver transplantation is feasible in cases that are evaluated as POST-TEXT stage IV after preoperative neoadjuvant chemotherapy, or stage III with invasion of important blood vessels such as the hepatic vein or inferior vena cava, which precludes surgery.
Children with hepatoblastoma who have indications for liver transplantation should be transferred to a transplant center for liver transplantation as soon as possible, as a long waiting time will significantly increase the postoperative recurrence rate and mortality rate of children with hepatoblastoma.
Laparoscopic hepatectomy
Recovery from laparoscopic hepatectomy is superior to conventional open liver surgery, with smaller surgical incisions, less bleeding and shorter hospital stays in patients who undergo laparoscopic surgery.
However, limited space for abdominal maneuvering remains a major obstacle to laparoscopic hepatectomy in children, and clinical evidence of long-term postoperative benefit is still lacking.
Chemotherapy
Chemotherapy, or chemotherapy for short, is a treatment method that uses chemically synthesized drugs to kill tumor cells and inhibit their growth. Currently, chemotherapy is often applied to hepatoblastoma after surgery to improve patient survival. Select chemotherapy regimen according to risk grouping.
Chemotherapy regimen for very low risk group
Children in the very-low-risk group are usually not treated with chemotherapy after surgery, and only need to be closely followed up.
Chemotherapy regimen for low-risk group
C5V regimen, i.e. cisplatin + 5-fluorouracil + vincristine, is commonly used.
Chemotherapy regimen for intermediate-risk group
C5VD regimen is commonly used, i.e. cisplatin + 5-fluorouracil + vincristine + adriamycin.
Other treatments
Interventional therapy
For some immunocompromised children with poor functional status who cannot tolerate systemic chemotherapy, transcatheter arterial chemoembolization (TACE) can be performed for local chemotherapy followed by surgical resection.
Some studies have shown that after TACE, the operation time is significantly shortened, bleeding is reduced, the weight of the resected tissue is lighter, the traumatic stress caused by the operation is significantly reduced, and the quality of life of the children is significantly improved.
Radiofrequency ablation therapy (RFA)
RFA can be tried for multiple, inoperable lesions after treatment.
High-intensity ultrasound focused knife therapy
High-intensity ultrasound focused knife therapy is also an option for children with refractory multifocal, inoperable liver transplantation and residual disease after surgery.
Cutting-edge treatment
Tumor diagnosis and treatment have entered the molecular era, but efficient therapeutic targets for hepatoblastoma have not yet been identified.
Small clinical trials have found that sorafenib in combination with irinotecan results in remission in approximately 80% of patients with relapsed/refractory hepatoblastoma, and the combination of the two drugs still holds promise for partial remission in patients who are resistant to the single agent.
Most targeted drugs such as MEK inhibitors, PI3K inhibitors, PLK1 inhibitors, PARP1 inhibitors, mTOR inhibitors, etc. are still in the clinical trial stage and are not yet available for clinical use.
In terms of immunotherapy, case reports have shown that immunotherapy with pembrolizumab controlled hepatoblastoma disease progression for up to 22 months [4-8].
Questions you may be concerned about
What to do if you’ve survived hepatoblastoma for five years
Hepatoblastoma survival for five years without recurrence within five years, patients can usually achieve long-term survival with regular review to avoid recurrence of hepatocellular carcinoma.
Hepatoblastoma is a relatively common type of primary malignant tumor of liver, usually a solitary tumor, which may be caused by oral contraceptive pills during pregnancy or fetal alcoholism, etc. Symptoms such as loss of appetite, nausea and vomiting may occur, and the malignant tumor can be surgically removed, and later on the cancer can be prevented from recurrence or metastasis by means of radiotherapy and chemotherapy, and if there is no recurrence within five years, the patient should also go to the hospital regularly to check the Markers.
Exercise regularly to improve one’s immune function, eat less spicy, stimulating and greasy food, avoid exposure to harmful substances, develop good living and dietary habits, and maintain a good and healthy weight.
Regular review is recommended, and if there are uncomfortable symptoms, timely consultation is needed.
Genetic testing methods for hepatoblastoma
There is no clear genetic test for Hepatoblastoma. Hepatoblastoma is diagnosed by serum alpha-fetoprotein level test, infected virus test, imaging test and pathology test.
1. Serum alpha-fetoprotein level test: also known as AFP level test, most patients have abnormally elevated serum AFP level, and the degree of elevation is related to the condition.
2. Virus infection test: mainly to detect whether the child has been infected with hepatitis B virus, if infected, the risk of hepatoblastoma is increased.
3. Diagnosis through imaging to diagnose the structure, size, nature of the mass and its relationship with the surrounding tissues.
4. Pathological examination: Pathological examination is the basis of definitive diagnosis of hepatoblastoma, which can stage and classify the disease.
At present, the genetic testing of hepatoblastoma is still in the exploratory stage, and the testing method is still unclear, so it is recommended to go to specialized hospitals for relevant examinations.
Prognosis
Cure
Clinical staging and typing of hepatoblastoma patients in the clinic is a key factor in evaluating and judging the quality of patient prognosis, and the overall 5-year survival rate is about 80% [11-12].
Special reminder:
The overall survival time of tumor patients can be roughly predicted by the 5-year survival rate, which refers to the proportion of patients whose tumors survive for more than 5 years after various comprehensive treatments.
The probability of recurrence after 5 years is very low and can generally be regarded as a clinical cure.5-year survival rate is only used for clinical research and does not represent the specific survival of an individual.The individual survival of patients needs to be determined by combining a number of factors, and it is recommended to consult with the physician who visits the clinic.5-year survival rate can be used to predict the overall survival time of a patient.
Prognostic factors
Prognostic factors are factors that have an impact on the overall survival and quality of life of patients [1,9-10].
Prognostic factors
Children diagnosed under 3 years of age.
No distant metastasis.
AFP ≤100ng/mL.
Well-differentiated fetal type.
Early PRETEXT staging.
Low risk grouping.
Poor prognostic factors
Diagnosed children and adults over 3 years of age.
Presence of distant metastases.
AFP >100ng/mL.
Coarse trabecular and small cell undifferentiated types.
Late PRETEXT staging.
High risk grouping.
Questions you may be concerned about
Can hepatoblastoma be cured with a liver transplant?
Hepatoblastoma is potentially curable if a liver transplant is performed.
Liver transplantation has been explored for more than half a century and has achieved greater results, and the 3-year survival rate after liver transplantation is now close to 80%.
Indications for liver transplantation include end-stage liver disease, benign and malignant lesions of the liver for which there is no other effective treatment. Hepatoblastoma is potentially curable if it progresses to an advanced stage and undergoes liver transplantation.
There are many types of liver transplantation, including classical liver transplantation in situ, dorsal camelid and modified dorsal camelid liver transplantation, and other types of liver transplantation, including split liver transplantation, living relative liver transplantation, reduced volume liver transplantation and allogeneic-assisted liver transplantation, etc., but they are not carried out as widely as the classical types.
Is the cure rate of hepatoblastoma high?
The overall cure rate of hepatoblastoma is relatively high, around 80%. For stage I stage II, the survival rate can be 80%~90%, while the survival rate for stage IV is still lower.
Hepatoblastoma cure rate or treatment effect is closely related to clinical stage. Early stage hepatoblastoma is completely resected by surgery, because the disease is sensitive to chemotherapy, so with chemotherapy after surgery, the cure rate of the disease is still quite high.
In the late stage, there is no chance of surgery when the patient arrives at the hospital, but through comprehensive treatment, such as preoperative chemotherapy, followed by surgical resection, and then standardized chemotherapy, there are still many patients who can get better treatment results.
After completing the treatment as prescribed by the doctor, regular follow-up should be done to avoid recurrence. Meanwhile, in daily life, children should be provided with nutritionally balanced diets, encouraged to have moderate activities, and given positive emotional encouragement.
Is Hepatoblastoma serious?
Hepatoblastoma is serious and is one of the most common malignant tumors in children.
Hepatoblastoma is common in children, is a kind of embryonic tumor with high malignant degree, which is rare in clinic, and the symptoms are not specific, and its treatment is mainly based on surgery, and the therapeutic effect is different in different patients.
1. Clinical symptoms: Hepatoblastoma has no specific clinical symptoms, which often include loss of appetite, weight loss or no weight gain, epigastric distension and pain, etc. Abdominal swelling is also more common, and most of the children consult the doctor because of abdominal enlargement.
2. Treatment: Surgery is the main treatment, supplemented by chemotherapy, radiotherapy or immunotherapy. If it is a single small lesion, the prognosis of surgical resection is better; if the tumor is huge or has metastatic foci, it should be combined with systemic chemotherapy after surgery, which can improve the survival rate of patients after surgery.
Hepatoblastoma has a better prognosis, and some studies say that the overall survival rate after 1, 3 and 5 years of comprehensive treatment is 93.7%, 84.0% and 73.9% respectively.
If patients are diagnosed with hepatoblastoma, it is recommended that they go to a regular hospital to evaluate their condition and follow the doctor’s instructions for treatment to avoid delays.
Daily
Daily Management
Dietary management
For infants and young children:
Safe, nutritious and easy-to-digest breastfeeding is recommended for children under 6 months of age.
If breastfeeding is not possible due to various reasons, appropriate formula can be chosen for feeding.
For children over 4-6 months old, complementary foods should be added scientifically under the premise of guaranteeing milk quantity to ensure that the combination of complementary foods and breastmilk (or powdered formula) can provide comprehensive nutrition for the child.
Breastfeeding mothers are advised to have a light, easy-to-digest, nutritious diet, avoiding spicy, greasy and allergy-inducing foods; and consume protein-rich foods such as beef and mutton, fish, eggs and milk.
For larger children and adults:
Diet should be reasonably arranged to achieve a light diet, nutritional balance, rich and diverse food types.
More vitamin-rich fresh fruits and vegetables can be consumed to supplement the vitamins needed by the body and promote recovery.
Eat more protein-rich foods, such as eggs, milk, lean meat, fish and so on.
Pickled, fried and deep-fried foods should be avoided.
Life management
Family members provide a quiet and comfortable environment to ensure that the child has a good sleep.
Pay attention to the body hygiene of the child, clean and moisturize well.
Clothes and diapers need to be made of soft, absorbent and non-irritating cotton, avoid wearing clothes made of artificial fibers and other materials, and do not use alkaline detergents such as soap.
Adult patients should quit smoking and drinking, have a regular routine, avoid staying up late, and exercise moderately.
Psychological support