Childhood Cancer


July 31, 2023 Word for Word Media 0Comment

 Prof Gita Naidu educates us on hepatoblastoma, a rare childhood cancer of the liver. 

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What is hepatoblastoma?

Hepatoblastoma is a cancer of the liver in children under three years of age and affects 1-2 million children globally.


  • A painful lump in the middle or upper right side of the abdomen.
  • Nausea and vomiting
  • Loss of appetite
  • Yellow-coloured skin or eyes
  • Unexplained weight loss

 What causes hepatoblastoma?

  • Premature birth
  • Low birth weight
  • Early exposure to hepatitis B
  • Biliary atresia
  • Hemihyperplasia
  • Beckwith-Wiedemann syndrome
  • Familial adenomatous polyposis
  • Aicardi syndrome
  • Glycogen storage disease
  • Simpson-Golabi-Behmel syndrome
  • Edward’s syndrome

How is hepatoblastoma diagnosed?

  • Alpha-fetoprotein tumour marker test (sample of blood is taken).
  • Imaging studies:
  1. Vascular ultrasound: blood vessels entering and leaving the liver
  2. Liver and doppler ultrasounds
  3. MRI


Pre-treatment extent of disease (PRETEXT): the two lobes are divided into four sections. The groups are based on the number of sections with tumours.


  • Upfront surgery to remove the tumour, followed by chemotherapy.
  • Options for newly diagnosed hepatoblastoma that can’t be removed by surgery or is not removed at the time of diagnosis may include the following:
  1. Combination chemotherapy to shrink the tumour, followed by surgery to remove the tumour.
  2. Combination chemotherapy, followed by a liver transplant.
  3. Chemoembolisation of the hepatic artery to shrink the tumour, followed by surgery to remove the tumour.
  4. If the tumour in the liver can’t be removed by surgery but there are no signs of cancer in other parts of the body, the treatment may be a liver transplant.
  • For newly diagnosed hepatoblastoma that has spread to other parts of the body at diagnosis:
  1. Combination chemotherapy to shrink the liver tumours and metastases.
  2. After chemotherapy, imaging tests are done to check whether the tumours can be removed by surgery. Treatment options may include the following:
  3. Surgery: If the tumour and metastases can be removed, followed by chemotherapy.
  4. If the metastases can’t be removed or a liver transplant isn’t possible, chemotherapy, chemoembolisation of the hepatic artery, or radiation therapy may be given.

Can hepatoblastoma be cured?

About 90% of children with early-stage disease are alive five years after treatment and about 75 to 85% of children with late-stage disease are alive five years after treatment.

Suggested questions for parents to ask

  1. What is the stage?
  2. What are treatment options?
  3. If surgery is an option, what surgery is recommended, and why?
  4. What are surgery side effects?
  5. Are there other treatments?
  6. Can these treatments cure my child?
  7. What is my child’s prognosis?
  8. What are the long-term complications of the disease and treatment?
PROF Gita Naidu

MEET THE EXPERT – Professor Gita Naidu

Professor Gita Naidu MBChB, FC (Paediatrics), MMed (Paediatrics), PhD is the Head of Paediatric Oncology, Chris Hani Baragwanath Academic Hospital, Academic Head: Paediatric Oncology, University of the Witwatersrand and the Chair of South African Children’s Cancer Study Group.

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