There are several ways to treat hepatoblastoma. Treatment options might include chemotherapy, surgery to remove the tumor (also called tumor resection) and liver transplantation.
Chemotherapy is a key part of treatment for nearly all infants and children with hepatoblastoma. Chemotherapy is used to both shrink the primary liver tumor and to treat any hepatoblastoma that has escaped outside the liver. This is important for patients with all stages of the disease, because cancer cells might have traveled to other parts of the body, possibly in amounts too small to be detected by doctors. A rare exception to the need for chemotherapy is found in infants and children with COG stage I disease of a less aggressive type called pure fetal hepatoblastoma. For all other infants and children, chemotherapy is given before and / or after surgery.
Tumor removal / resection: Many factors are considered when assessing whether a tumor can be safely removed from a child’s liver such that enough normal liver remains. One of the factors that doctors consider is the degree of liver involvement. For example, some children have a single tumor, while other children have multifocal disease (more than one tumor in the liver). Some tumors involve just one or two liver lobes, while others involve three or four liver lobes. Some tumors encroach upon vital structures within the liver, while others do not invade such structures. For patients who have limited disease when the tumor is discovered, tumor resection (removal) can be considered at diagnosis. This is true for approximately a third of children with hepatoblastoma. Of the children whose tumors are not resectable at diagnosis, their tumors can sometimes become resectable after a few cycles of chemotherapy.
Liver transplantation has also been used successfully in combination with chemotherapy to treat hepatoblastoma. Liver transplantation is usually used in cases where the tumor is located only in the liver and is unable to be removed by surgery. In these cases, the liver that contains the tumor is completely removed and replaced with a liver from a donor. Like with other surgeries for hepatoblastoma, chemotherapy is used before and often after liver transplantation to control the cancer. For infants and children who have unresectable hepatoblastoma (via conventional surgical approaches) and have cancer outside of the liver (aggressive COG stage IV disease), liver transplantation can still be used as part of the treatment plan successfully in certain circumstances, particularly when the disease outside the liver disappears with chemotherapy.
Many factors are considered when designing a treatment plan for an individual infant or child, and all treatment options should be discussed thoroughly between the care team and the family. Do not be afraid to ask questions and take an active role in the treatment plan for your child.