There are a few ways to treat hepatoblastoma. This may include chemotherapy, surgery to remove the tumor (also called tumor resection) and liver transplantation.
Chemotherapy (Chemo) is a key part of treatment for nearly all infants and children with hepatoblastoma. Chemo is used to both shrink the primary liver tumor, and to treat any hepatoblastoma that has escaped outside the liver. This is needed for patients with all stages of the disease, because cancer cells might have traveled to other parts of the body. These cancer cells may be in amounts too small to be found by doctors. Infants and children with COG stage I disease of a less aggressive type called pure fetal hepatoblastoma may not need chemo. For all other infants and children, chemo is given before and / or after surgery.
Tumor removal / resection: Many factors are looked at when checking if a tumor can be safely removed from a child’s liver leaving enough normal liver. One of the factors that doctors look at is the degree that the liver is involved. For instance, 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. Tumor resection (removal) can be discussed at diagnosis for patients with limited disease at this point. This is true for around 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 chemo.
Liver transplantation has also been used with success with chemo to treat hepatoblastoma. Liver transplants are most often used in cases where the tumor is only in the liver and is not able to be removed by surgery. In these cases, the liver with the tumor is fully removed and replaced with a liver from a donor. Like with other surgeries for hepatoblastoma, chemo is used before and often after liver transplant to control the cancer. In some cases, infants and children who have hepatoblastoma that cannot be resected by normal surgery and have cancer outside of their liver (aggressive COG stage IV disease), can still have a liver transplant with success. An example of when this may be possible is when the disease outside the liver goes away with chemo.
Many factors are looked at when making a treatment plan for each child. The care team and the family should discuss all options fully. Do not be afraid to ask questions and take an active role in the treatment plan for your child.