Childhood hepatoblastoma

　　The exact etiology of this disease is not yet clear. Case reports suggest that the occurrence of HB may be related to fetal alcohol intoxication or maternal oral contraceptives. Others believe that the disease may be associated with variants in the 11p allele. Pathologically, the tumor appears to be immature, with varying degrees of differentiation of liver tissue, and can be divided into three subtypes: fetal type (highly differentiated), embryonal type (lowly differentiated), and undifferentiated type (immature).

　　Children with this disease often have complications such as umbilical hernia, diaphragmatic hernia, intestinal malformation, renal malformation, and other congenital malformations and metabolic disorders. The disease can also cause premature puberty, secondary anemia, ascites, lower limb edema, and occasional upper gastrointestinal bleeding and jaundice.

　　At the initial stage of the disease, the general symptoms are not obvious, there is no jaundice or fever. Abdominal distension can be discovered by parents during bathing, or sometimes by doctors during health checks when an abdominal mass is found. Older children may complain of abdominal pain. Hepatocellular carcinoma may sometimes produce gonadotropin, causing premature puberty in children. Some children may see pigmentation on the skin, and some may not feel abdominal pain. The course of the disease progresses rapidly compared to general malignant tumors, and may include symptoms such as decreased appetite, fatigue, and progressive weight loss. In the late stage, symptoms may include fever, secondary anemia, ascites, lower limb edema, occasional upper gastrointestinal bleeding, and jaundice. Palpation shows an enlarged, hard liver with明显 hard edges, an irregular surface, and nodules.

　　The etiology of this disease is not yet clear and may be related to the fetal period. Mothers can refer to the general preventive methods for tumors, understand the risk factors for tumors, and formulate corresponding prevention and treatment strategies to reduce the risk of tumors. There are two basic clues for preventing the occurrence of tumors, even if the tumor has already started to form within the body; they can also help the body improve its resistance. The following strategies are described as follows:

　　1. Avoiding harmful substances (carcinogenic factors) can help us avoid or minimize contact with harmful substances.

　　Some related factors of tumor occurrence can be prevented before the onset. Many cancers can be prevented before they form. In 1988, a report from the United States compared the international situation of malignant tumors in detail and proposed that the external factors of many known malignant tumors are preventable in principle, that is, about 80% of malignant tumors can be prevented through simple lifestyle changes. Continuing to trace back, Dr. Higginson's research summary in 1969 concluded that 90% of malignant tumors are caused by environmental factors. 'Environmental factors' and 'lifestyle' refer to the air we breathe, the water we drink, the food we choose to make, the habits of activity, and social relationships, etc.

　　2. Improving the body's immune resistance to tumors can help improve and strengthen the body's immune system in the fight against tumors.

　　The focus of our current tumor prevention and treatment work should be to first pay attention to and improve those factors closely related to our lives, such as smoking cessation, reasonable diet, regular exercise, and weight loss. Anyone who adheres to these simple and reasonable lifestyle common sense can reduce the chance of getting cancer.

　　The most important thing to improve immune system function is: diet, exercise, and controlling stress. A healthy lifestyle choice can help us stay away from cancer. Maintaining a good emotional state and appropriate physical exercise can keep the body's immune system in the best condition, which is also beneficial for the prevention of tumors and other diseases. In addition, studies have shown that moderate exercise not only strengthens the human immune system but also reduces the incidence of colorectal cancer by increasing the peristalsis of the human intestinal system.

　　When conducting laboratory tests for infantile hepatoblastoma, the detection of serum alpha-fetoprotein is extremely important for the diagnosis of liver cancer, with 90% to 100% positivity, which is higher than in adult cases (70% to 80% positivity in adults). Many biochemical substances such as proteins, lipids, enzymes, etc., are produced or metabolized in the liver, so the examination of blood cholesterol, lactate dehydrogenase (LDH), albumin, globulin, alkaline phosphatase, bilirubin, etc., can reflect liver function and are all necessary. Serum alkaline phosphatase is often elevated, which is also helpful for the diagnosis of liver cancer.

　　In addition to laboratory tests, ultrasonography, intravenous urography, and radionuclide liver scanning are all helpful in diagnosing this disease. CT and MRI (magnetic resonance imaging) are of reference value for diagnosis, and when performing chest X-ray fluoroscopy and photography, attention should be paid to the diaphragm condition and the lungs.

　　In addition to conventional treatment methods, children with hepatoblastoma should pay attention to a light diet, eat more vitamin-rich foods, and ensure the follow-up of nutrition. At the same time, they should avoid spicy and irritating foods.

　　Infantile hepatoblastoma is a mixed tissue of epithelial and mesenchymal origin, which can contain fibrous tissue, muscle, osteoid tissue, cartilage, hematopoietic tissue, or primitive mesenchymal tissue. Its specific treatment methods are as follows.

　　One, Clinical Staging Treatment Principles (SIOPEL-Ⅰ Staging)

　　1. Stage I: Resection of a part of the liver lobe or resection of the corresponding liver segment.

　　2. Stage IIa1: Resection of the right liver lobe; Stage IIa2: Resection of the left liver lobe.

　　3. Stage IIb: Resection of the corresponding liver segment.

　　4. Stage III1, IIIA2: Semicircular liver resection or combined chemotherapy should be performed first, and then surgery should be performed after the tumor has been reduced.

　　5. Stage IIIb1, IIIb2: Combined chemotherapy should be performed first, and then liver resection of the corresponding involved site should be performed after the tumor has been reduced.

　　6. Stage IV: Liver transplantation can be performed after combined chemotherapy or radiotherapy.

　　7. If there is distant metastasis, extrapulmonary infiltration, and involvement of blood vessels in any stage, combined chemotherapy should be performed first, and the decision on whether to perform surgical treatment should be made based on the effect of chemotherapy.

　　Two, Surgical Treatment

　　Early complete surgical resection can cure this disease. It is easy to resect tumors with a mass-like morphology, but it is difficult to resect tumors with multiple nodules or diffuse infiltration, and sometimes it becomes impossible. Tumors involving both lobes or invading veins and inferior vena cava cannot be completely resected. If the anesthesia and surgical techniques are excellent, liver resection can reach 80% of the liver, and the liver can regenerate quickly within 6 months after resection. The liver regeneration ability of children is better than that of adults. Liver cancer should be treated with surgical resection as soon as possible when it is localized in one lobe. For large liver cancers, radiotherapy and chemotherapy can be used in combination first, and then surgical resection can be performed after the tumor has shrunk. Some case reports have shown that long-term survival can be achieved by radical resection after the tumor has shrunk.

　　Three, Chemotherapy and Radiotherapy

　　After the complete resection of the tumor, chemotherapy should be performed, and radiotherapy should be performed as needed. Caution should be exercised when radiotherapy is performed when there is not much remaining liver. The liver tissue of children is very sensitive to chemotherapy drugs and radiation, so it is generally advocated that chemotherapy or radiotherapy can be performed 1-2 months after surgery to avoid hindering the regeneration of normal liver cells after surgery. Chemotherapy drugs include vincristine, cyclophosphamide, fluorouracil (5-FU), doxorubicin (adriamycin), etc., but the efficacy is not as good as that for neuroblastoma and renal embryonal tumor. Some people have reported that the use of fluorouracil (5-FU) injected via the hepatic artery achieved certain efficacy, and some have mentioned that the combined use of fluorouracil (5-FU) and vincristine is effective.