Pediatric liver tumors

　　Although there is a certain understanding of the causes of pediatric liver tumors after many studies, the exact cause is still unclear. Current research believes that the pathogenic factors are:

　　1. About 80% of patients with liver cell liver cancer have cirrhosis, and most of them are large nodular cirrhosis. This may be due to the degeneration and necrosis of liver cells, the proliferation of interstitial connective tissue, the formation of fibrous septa, and the nodular regeneration of residual liver cells, forming lobules. During the repeated proliferation process, liver cells may undergo variation and eventually lead to cancer.

　　2. The relationship between viral hepatitis B and liver cancer is relatively close. Patients with positive HbsAg have a significantly higher incidence of liver cancer than those with negative HbsAg. There is also a close relationship between hepatitis C and the occurrence of liver cancer.

　　3. After the intake of food containing aflatoxins, they are absorbed through the digestive tract, reach the liver, cause liver cell degeneration and necrosis, and then undergo proliferation and transformation into cancer.

　　4. Chemical carcinogens now clearly identified include nitrates and nitrites.

　　5. The occurrence of liver cancer is generally related to the low immune function of antibodies, especially closely related to the low cellular immune function.

　　The survival rate of hepatoblastoma patients who undergo complete surgical resection is 85%, while the survival rate of hepatocellular carcinoma is only 9% to 35%. Patients with incomplete tumor resection often have local recurrence and eventually die. This disease often complicates with jaundice, ascites, osteoporosis, and can also lead to multiple fractures, anemia, and thrombocytosis.

　　Hepatic tumors in children are mainly manifested as irregular and localized liver enlargement as the initial symptom, with the mass located in the right abdomen or upper right quadrant. The medical history often records rapid tumor growth, with some reaching below the navel or beyond the midline. The tumor surface is smooth, the edges are clear, the hardness is moderate, it can move slightly to the left and right, and there is no tenderness. In the early stage, except for mild anemia, the general condition is usually good, while in the late stage, jaundice, ascites, fever, anemia, and weight loss may occur. The abdominal wall may show dilated veins, and respiratory difficulty may occur due to a large abdominal mass, with about 20% of hepatoblastoma cases having osteoporosis, which can lead to multiple fractures in severe cases.

　　Many patients have anemia and thrombocytosis when they seek medical attention, especially common in children with hepatoblastoma. The liver function of children with hepatoblastoma is often normal, but the liver cell carcinoma cases due to concurrent hepatitis or liver cirrhosis, the serum bilirubin, alkaline phosphatase, and transaminase may be increased. 60% to 90% of liver cell carcinoma cases and more than 90% of hepatoblastoma cases have increased alpha-fetoprotein. The urine of children with hepatoblastoma has increased excretion of cystathionine.

　　Other common primary liver tumors include cavernous hemangioma and angioma of vascular endothelial cells. The former can compress liver tissue due to tumor growth, causing liver cell degeneration. Sometimes there may be arteriovenous shunts within the tumor, which can lead to pediatric heart failure or death due to tumor rupture and bleeding. Small hemangiomas grow slowly and may not have clinical symptoms.

　　Angioma of vascular endothelial cells is malignant, with the formation of blood sinusoids in the liver. Clinically, there may be pain, high fever, and jaundice. The course of the disease is slow, but the prognosis is poor.Hepatic hamartoma, teratoma, and solitary or multiple liver cysts are extremely rare..

　　The etiology of this disease is not yet known, and it can be referred to the general methods of tumor prevention. Understanding the risk factors of tumors and formulating corresponding prevention and treatment strategies can reduce the risk of tumors. There are two basic clues for preventing the occurrence of tumors: even if tumors have started to form in the body, they can also help the body improve its resistance. The following strategies are described:

　　Avoiding harmful substances (carcinogenic factors) is to help us avoid or minimize contact with harmful substances.

　　Some related factors of tumor occurrence can be prevented before the onset of the disease. Many cancers can be prevented before they form. A report from the United States in 1988 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 by 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, our habits of activity, and social relationships, etc.

　　Enhancing the body's immunity 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 first be on improving those factors closely related to our lives, such as quitting smoking, reasonable diet, regular exercise, and weight reduction. Anyone who adheres to these simple and reasonable lifestyle common sense can reduce the chance of getting cancer.

　　The most important thing to improve the immune system function is: diet, exercise, and control of烦恼, the choice of a healthy lifestyle 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 state, which is also beneficial for the prevention of tumors and the occurrence of other diseases. In addition, research has shown that appropriate exercise not only enhances the human immune system but also reduces the incidence of colorectal cancer by increasing the peristalsis of the human intestinal system.

　　The examination of this disease includes laboratory tests and other auxiliary examinations. The continuous development of serology and imaging has provided various methods for the early diagnosis of subclinical liver cancer. Clinically, serological diagnosis is called 'qualitative diagnosis', imaging diagnosis is called 'localization diagnosis', and puncture biopsy or desquamated cell examination is called 'pathological diagnosis'. The comprehensive application of these methods can improve the accuracy of diagnosis.

　　1. Alpha-fetoprotein (AFP) detection

　　AFP has an accuracy rate of about 90% for liver cells, and not all AFP-positive patients have liver cancer. AFP false positives are mainly seen in hepatitis and liver cirrhosis, accounting for 80% of false positive cases. In addition, there are also germ cell tumors, digestive tract cancers, pathological pregnancy, liver vascular endothelioma, malignant liver fibrous tissue tumor, etc. For the diagnosis of AFP-negative patients, when AFP-negative cannot exclude the diagnosis of liver cancer, enzymatic tests can be performed, among which α1-antitrypsin (AAT), γ-glutamyl transferase (γ-GT), carcinoembryonic antigen (CEA), alkaline phosphatase (AKP) and other serological test results may rise in liver disease patients, but none of them are specific.

　　2. Liver biopsy

　　For those with a basically clear diagnosis, liver puncture examination can be omitted because liver puncture has certain complications, the most common being bleeding. In addition, when the needle is punctured, it may pass through the portal vein or hepatic vein and bile duct, which may lead to the spread of cancer cells into the blood vessels, causing metastasis.

　　3. Ultrasound

　　It can display tumors larger than 1 cm, with a correct diagnosis rate of 90%. It can display the size, location, shape, number, bile duct, portal vein, spleen, abdominal lymph nodes, etc., and can also make a diagnosis of liver cirrhosis, splenomegaly, and ascites.

　　4. CT

　　The accuracy rate of diagnosis for liver cancer is 93%, with the minimum resolution display being 1.5 cm. Its advantage is that it can directly observe the size, location, and relationship of the liver vein and portal vein of the tumor, and can also diagnose whether there are cancer emboli in the portal vein or hepatic vein.

　　5. Angiography

　　Hepatic angiography can understand the blood supply of the lesion to judge the possibility and indications of surgery, and can display a tumor of about 1.5 cm. It is the highest resolution diagnostic method in current imaging diagnostic methods and is of great significance in distinguishing liver hemangiomas. At the same time, it can also understand whether there is a variation in the hepatic artery, which is very helpful for liver resection surgery. If it is middle or late-stage liver cancer and cannot be treated surgically, embolization and (or) chemotherapy can be given.

　　6, MRI

　　It is basically consistent with CT, but it is helpful for some difficult-to-differentiate liver masses. T1 and T2 images can clearly distinguish liver cancer, liver hemangioma, liver abscess, cysts, and other conditions.

　　7, Radionuclide Scanning

　　For patients who are difficult to differentiate from hemangiomas, blood flow scanning can be used for differentiation, as the resolution of radionuclide scanning is low, and it is generally rarely used as a diagnostic method for liver cancer.

　　8, Laparoscopy

　　For patients who are difficult to diagnose, laparoscopic examination can be considered, directly observing the liver, liver surface mass, and intra-abdominal conditions.

　　9, X-ray Examination

　　Under X-ray fluoroscopy, the right diaphragm can be seen to be elevated, with restricted movement or localized prominence. In 30% of cases, calcification shadows can be seen within the tumor on X-ray films, and about 10% of cases have lung metastases at the time of diagnosis.

　　In terms of diet, children with this disease should mainly eat light and balanced meals, and can eat more things that enhance immunity, such as yam, turtle, kiwi, fig, apple, sardine, bee, milk, pork liver, etc. Red potatoes, apples, and carrots can also be eaten more.
　　　　

　　The most effective treatment for this disease is surgical resection of the lesion. Both benign and malignant tumors can be surgically removed, and about 95% of cases can be completely resected. The liver tissue can be rapidly repaired 4 to 6 weeks after surgery, and CT, AFP, and B-ultrasound should be re-examined at this time as a basis for future follow-up. Tumors are relatively insensitive to radiotherapy, and the combination of cisplatin and doxorubicin (adriamycin) is effective for hepatoblastoma, which can turn inoperable tumors into resectable lesions and can clear lung metastases. There is currently no effective treatment for extensive benign liver tumors that cannot be resected. For children with inoperable hemangiomas involving the left and right liver lobes, and for liver hemangiomas that cause heart failure and cannot be resected, ligation of the hepatic artery can be performed. Currently, it is advocated to perform hepatic artery catheter embolization treatment.