Hepatoblast­oma

Hepatoblastoma is a rare liver cancer that usually shows up in kids before age 3. It grows slowly, so you may not notice any changes in your child at first.

But then, they aren’t all that hungry. And they’ve lost weight. Or they may say their tummy hurts and throw up. They may have a lump or swelling in their belly (abdomen). And, most startling, their skin and eyes may turn yellow from jaundice. Often, hepatoblastoma stays in your child’s liver. But it can spread to other parts of their body (metastasize) if left untreated — particularly their lungs.

That’s why it’s important to find healthcare providers, like those at Cleveland Clinic Children’s, who are experienced in diagnosing and treating this childhood cancer. Hepatoblastoma may be rare, but it’s not rare to us.

What to expect at your first visit

Knowing that your child has a mass in their liver and making that first appointment with a pediatric cancer specialist can be overwhelming and stressful. We’re here to listen to your concerns, answer your questions and help you both understand what’s going on.

That’s why we’ll ask you to share your child’s story. We want to know what brought you to the appointment — what kinds of symptoms your child is having, how long they’ve had them and how they’ve been feeling overall. We’ll also do a physical exam and order some tests.

Testing for hepatoblastoma

Testing is an important part of confirming your child’s diagnosis. We’ll check their blood cells, look for certain proteins in their blood and see how their liver works with tests, like:

• Alpha-fetoprotein (AFP) test.
• Complete blood count (CBC).
• Comprehensive metabolic panel (CMP).
• Liver function tests.
• CT (computed tomography) scan.
• MRI (magnetic resonance imaging).
• Vascular ultrasound of the liver.
• Doppler ultrasound.
• Liver biopsy.

We know testing can be scary for little kids. And it can be hard for them to understand what’s going on. That’s why we have child life specialists who can explain things in an easy way for your child so they know what to expect and feel more comfortable.

Second opinions for hepatoblastoma

Hearing your child may have a rare liver cancer can feel overwhelming. But you also know that you want them to have the best care — from providers you trust. That’s why we encourage second opinions.

We know cancer doesn’t wait. So, when you and your child come to Cleveland Clinic Children’s for a second opinion, we work to schedule an appointment as soon as possible. Our experienced children’s healthcare providers spend time going over your child’s medical records to help you understand the diagnosis and what steps come next. Getting a second opinion can help you feel more in control of your child’s care and give you peace of mind, knowing they’re in the most capable hands.

Meet Our Hepatoblastoma Team

We believe in personalized, team-based care at Cleveland Clinic Children’s. Your child’s team of expert providers from different specialties works together to confirm a diagnosis and build a treatment plan focusing on your child’s needs. Their team may include:

• Pediatric oncologists.
• Pediatric hepatologists (liver specialists).
• Pediatric gastroenterologists.
• Pediatric radiologists.
• Child psychologists.
• Nurse practitioners.
• Social workers.
• Care coordinators (registered healthcare providers who help keep patients well-informed of their options and advocate on their behalf throughout treatment).

Your child’s personalized care plan is based on their age, medical history, where the tumors are, how many they have and how big they are. We also use a process called pre-treatment extent of disease (PRETEXT) to find out what stage (how advanced) the hepatoblastoma is. This is based on where the cancer is found in your child’s liver. Treatments for hepatoblastoma include:

Chemotherapy

We often suggest starting with medication (chemotherapy) to destroy cancer cells and shrink tumors (neoadjuvant chemotherapy). Surgery and chemo go hand-in-hand as the first hepatoblastoma treatments. We often use chemotherapy again after surgery to kill any remaining cancer cells.

Your child will have chemotherapy by mouth (oral), through a vein (IV) or as a shot (injection). We offer different types of chemotherapy, including:

• Local chemotherapy: Directly targets cancer cells in your child’s liver.
• Systemic chemotherapy: Targets cancer cells throughout your child’s body.
• Transarterial chemoembolization (TACE): Targets liver tumors by injecting an anticancer drug into the artery that sends blood to your child’s liver. Then, we inject a substance that blocks the artery, trapping the anticancer drug around the tumor.

Some of the chemotherapy that’s typically used to treat hepatoblastoma can cause hearing loss or heart problems. But at Cleveland Clinic Children’s, we use other medications whenever possible to protect your child from these side effects.

Surgery

Most children with hepatoblastoma need surgery (hepatectomy or liver resection) to remove tumors in their liver. The liver can regrow (regenerate) sections that are removed. Types of surgery include:

• Partial hepatectomy: Removes the section of their liver where the tumors are. A partial hepatectomy can be open surgery or minimally invasive (laparoscopic) surgery.
• Total hepatectomy: Removes their entire liver if tumors are too large for partial hepatectomy. After this surgery, we’ll do a liver transplant with a liver from a donor.

Ablation therapy

If hepatoblastoma comes back after treatment (recurs), we may suggest destroying the tumors without removing them through ablation therapy. Types of ablation therapy include:

• Percutaneous ethanol injection: Injects pure alcohol (ethanol) directly into a tumor.
• Radiofrequency ablation: Destroys the tumor using a thin probe that releases high-energy waves through a small incision (cut) in your child’s abdomen.

Recovery After Hepatoblastoma Treatment

If your child has a partial hepatectomy, they’ll stay in the hospital for several days. If they have open surgery, they should rest at home for four to eight weeks after leaving the hospital. They can usually return to regular activities after about 12 weeks. If they have minimally invasive surgery, they should rest at home for two to four weeks and, usually, return to their regular activities within six to eight weeks. They may need more chemotherapy, typically around two to four weeks after surgery.

If your child has a total hepatectomy and liver transplant, they’ll need to spend several days in the intensive care unit (ICU). They’ll get medications and fluids through an IV and stay in the hospital for one to three weeks as they recover.

You’ll take them to frequent checkups within the first month after the transplant. They can usually return to their regular activities within three months. Your child will need to take immunosuppressants for the rest of their life to prevent their body from rejecting their new liver.

Routine follow-up care

We’ll see your child regularly after hepatoblastoma treatment for follow-up exams and testing. We’ll check their overall health, make sure the cancer hasn’t come back and quickly take care of any health concerns.

Taking the Next Step

It’s hard to know where to turn when your child has a rare type of cancer. But getting expert care for hepatoblastoma right away will give your child the best possible results and a chance for a good recovery. Our solid tumor team specializes in helping families move through a hepatoblastoma diagnosis and find the best treatment for their child’s needs. We’re here to help your child go on to lead a full, active life.