While rare (affecting only 2 to 3 per one million individuals), hepatoblastoma is considered to be one of the more common forms of liver cancer that impacts children. In 2016, Canadian singer Michael Buble’s then 3-year-old son was diagnosed with hepatoblastoma, sparking an increase in conversation surrounding the disease.
Hepatoblastoma is a cancerous tumour that starts in the liver and typically presents as a painful abdominal mass. In comparison to hepatocellular carcinoma (also known as HHC), which is more common in adults, hepatoblastoma tends to be diagnosed in children under the age of 3 and is more commonly seen in infancy as well as in a high percentage of children born prematurely. However, it can also be seen between the ages of 10 and 16. While health experts have not been able to determine a definitive cause of hepatoblastoma, some childhood cancer organizations have linked it to rare genetic conditions such as Beckwith-Wiedemann syndrome. Classified as an overgrown syndrome, this is a condition that can affect many different parts of the body. For example, an infant may be larger than average, while a child may appear taller than their peers. Certain parts of the body may appear larger than the other, leading to an appearance that seems asymmetrical or uneven in nature. By age 8, however, growth starts to slow down. The warning signs and symptoms associated with Beckwith-Wiedemann syndrome vary from child to child. Some may be born with abdominal wall defects, have larger abdominal organs, kidney problems, low blood sugar, as well as issues with breathing, swallowing and speaking. Other genetic diseases that have been linked to hepatoblastoma include Wilson disease (in which there is an abnormal build-up of copper in some of the body’s vital organs), porphyria cutanea tarda (which manifests in the skin and causes blisters), as well as familial adenomatous polyposis (an inherited disorder that causes cancer of the colon and rectum.)
As for the symptoms of hepatoblastoma, many of the symptoms of liver cancer in children will often go unnoticed or be quite vague – at least initially. However, as mentioned, hepatoblastoma often causes abdominal pain and swelling – which are the most common symptoms associated with this particular form of liver cancer. In addition, a child with hepatoblastoma may also experience unexplained weight loss, loss of appetite, fever, fatigue, nausea, vomiting, dark urine, as well as yellowing of the skin and/or eyes (also known as jaundice.)
There are a number of ways in which hepatoblastoma can be diagnosed. It can be diagnosed through medical imaging tests, such as X-rays, ultrasounds, CT scans, or MRI scans, or through blood tests. It can also be diagnosed through a surgical procedure known as a laparoscopy. In some cases, a biopsy (tissue sample) may be taken from the tumour during the laparoscopic procedure so that it can be examined more thoroughly in a laboratory. If it is determined that a child does, in fact, have hepatoblastoma, more tests will be done to determine the stage of the cancer and whether or not it has metastasized (spread) to other areas of the body. This type of cancer is most commonly spread from the bloodstream to other organs such as the lungs and the abdomen. If the cancer has spread, it is most likely considered to be a in a third or fourth stage. The stage of which the cancer is in will also determine which type of treatment the child receives. In many cases, a child will receive a combination of both chemotherapy and radiation therapy to kill the cancer cells and reduce the size of the tumour prior to any surgery to remove the cancer and the area of the liver in which the cancer initiated. Liver transplantation is also an option in some cases.