Alexia Allen 

Abstract

In this article, extensive research was conducted on pediatric hepatoblastoma, the most common type of liver cancer. While this type of cancer is rare among children, this disease has many complexities. In this research, one will be able to familiarize themselves with the origins of this disease. After understanding how and why hepatoblastoma occurs in children, one will understand how this disease is diagnosed and treated and the technologies and people involved in this treatment. After understanding how pediatric hepatoblastoma cases are treated, the history of how this disease is treated will be outlined, and what is being done to advance further treatment. To conclude the research, statistics concerning the disease and its cases will be mentioned, as well as ways to advocate and bring public awareness of this disease. Even though one author conducted this research, the authors used many resources from scientists, physicians, and textbooks to create the most accurate and thorough research about this disease. 

Keywords: Pediatric hepatoblastoma, origins, diagnosis, treatments, statistics, and awareness 

Pediatric Hepatoblastoma 

Hepatoblastoma is a cancer that forms in the tissues of the liver. It is the most common type of childhood liver cancer and usually affects children younger than three years of age. This disease needs urgent treatment because the liver is one of the largest organs in the body.  It has two lobes and fills the upper right side of the abdomen inside the rib cage. Three of the many essential functions of the hepatic, or liver organ are the following: to make bile to help digest fats from food, to store glycogen (sugar), which the body uses for energy, and to filter harmful substances from the blood so they can be passed from the body in stools and urine. In hepatoblastoma, the histology, which is how the cancer cells look under a microscope, affects how the cancer is treated. Pediatric hepatoblastoma is not commonly treated in medicine, so to understand how cases of this disease should be treated, one needs to grasp all aspects of this disease. This research aims to identify the origins of hepatoblastoma, signs and symptoms of this disease, diagnosis, staging, treatment, complications, and advancement of the treatment. In addition to understanding how complex this type of cancer is, it will also be explained that this disease needs to have more research, and the people in the medical community (and others) should desire to raise awareness in knowledge concerning hepatoblastoma.

The Cause of Pediatric Hepatoblastoma 

How many cancer is formed 

To grasp how complex the topic of pediatric hepatoblastoma is, it is critical to know any type of cancer, primarily how cancer is formed in the body. Cancer is a common type of disease in which one’s cells uncontrollably multiply rapidly and eventually spread to other anatomical organs. Cancer can initially develop anywhere in the body, consisting of trillions of individual cells. In normal circumstances, cells grow and multiply through cell division to replace old or damaged cells. When cancer develops, cell division breaks down, and the abnormal or damaged cells grow and multiply instead of being replaced, which should not happen. These cells have a great chance of forming tumors. Tumors are unnecessary lumps of tissue. Even if a tumor is formed, it does not inherently mean it is dangerous to the body, which means the tumor is benign or non-cancerous. 

Malignant, more commonly known as cancerous tumors, multiply and invade nearby tissues and can undergo metastasis. Metastasis is a process in which malignant tumors migrate to new places in the body and form new tumors in that area. In most types of cancers, hepatoblastoma includes cancerous solid tumors. Malignant cells form because of an issue regarding the body’s genetic makeup, specifically damage within the body’s deoxyribonucleic acid, more commonly known as DNA. DNA damage is caused by harmful substances in the body, such as smoke or excess exposure to ultraviolet rays. Pediatric hepatoblastoma, which is a type of cancer that initially develops in the liver, is typically caused by a complication in fetal development in the womb. Still, several factors can lead to a child developing this disease. 

Risk Factors for Developing Pediatric Hepatoblastoma

Since the foundation of how any type of cancer forms has been overviewed, understanding the causes of hepatoblastoma will seem less complex. As stated, hepatoblastoma is primarily caused by specific changes in how hepatic cells (liver cells) function, grow, and divide. A risk factor in this context is any potential thing in the body’s anatomy or environment that can increase the chance of developing a disease, such as hepatoblastoma, during early childhood. It is critical to mention that just because a child has one or more of these factors does not mean that they will develop hepatoblastoma. In some cases, children are diagnosed with hepatoblastoma who did not have any known risk factors before diagnosis. Children who are born prematurely, have an abnormally low birth weight or have genetic conditions are at a higher risk for developing hepatoblastoma. The main genetic conditions associated with developing hepatoblastoma include Aicardi syndrome, Beckwith-Wiedemann syndrome, hemihyperplasia, and trisomy 18. The reason why children with these genetic and developmental deformities are at risk for developing hepatoblastoma is that the cells located in the child’s genetic makeup are prone to mutations, leading to cancer forming and undergoing metastasis. 

Laboratory research has been conducted to find the reason why children are born prematurely, and that has genetic conditions leading to the development of pediatric hepatoblastoma. Liqin Zhu, PhD, St. Jude Department of Pharmacy and Pharmaceutical Sciences, did the most successful research. During her study, she and her team found that premature cells have led directly to the development of cancer, specifically hepatoblastoma. In this direct pathway to hepatoblastoma, the proteins Cxcl1/Cxcr2 work by the liver, secreting the chemokine Cxcl1, which sends signals to its receptor Cxcr2 on hepatoblastoma cells. Chemokines are small signaling proteins secreted by cells and are significant mediators of tissue inflammation. The researchers found that this Cxcl1/Cxcr2 pathway is only active in immature livers but not in more developed livers and that they have a direct correlation to hepatoblastoma cases in children. Even though research to find the direct cause of pediatric hepatoblastoma has been undertaken over the past few years, the finding of the exact cause of pediatric hepatoblastoma has yet to be discovered. Because there is not a direct cause of pediatric hepatoblastoma has not been found yet, the most straightforward alternative to directing if hepatoblastoma is present in a child is by their signs and symptoms. 

Signs and Symptoms of Pediatric Hepatoblastoma 

When hepatoblastoma is present in a child, the child may not display any signs or mention any symptoms until the tumor has grown to a significant size. While a large tumor still can be successfully treated, it is far more effective to detect that a child has hepatoblastoma sooner rather than later. To detect hepatoblastoma as quickly as possible, children with risk factors for developing hepatoblastoma are recommended to get an abdominal ultrasound exam and a blood test every three months from birth until the child is four years of age. If someone questions if their child possibly has hepatoblastoma, they must contact their child’s pediatrician. The following symptoms can indicate that a child has hepatoblastoma: “a lump in the abdomen, swelling in the stomach, pain in the stomach, weight loss for no known reason,  loss of appetite, or nausea and vomiting. These signs and symptoms can indicate a variety of illnesses that a child can have, so to get a proper diagnosis, consulting your child’s primary care physician is critical. 

The Diagnosis of Pediatric Hepatoblastoma 

Consulting a Physician 

The first step of the diagnostic process for pediatric hepatoblastoma is to contact a child’s primary care physician. The pediatrician will most likely ask the patient's parent and the child to come in for an evaluation to see any signs of hepatoblastoma that the child is potentially presenting and to talk with the patient and their parent about potential testing options. Even though speaking with a child’s primary physician is essential in this diagnosis because the physician knows their medical history, it is necessary to seek another opinion from a different physician to see if there is a differential diagnosis and to find out what treatment plan would be best for a child to undergo if testing positive for hepatoblastoma. There are several ways to test if a child has hepatoblastoma; however, the methods of testing below are proven to be the most accurate ways of testing that typically don't bring out a differential diagnosis when multiple pediatricians review the results.

Serum Tumor Marker Test 

The purpose of a serum tumor marker test is to record and identify the amount of certain substances that are released into one’s blood by the body’s organs, tissues, or even present tumor cells. Certain substances are linked to certain cancers based on whether the level of these substances in the patient’s blood is abnormally high; this is called a tumor marker. The blood of children with hepatoblastoma has increased amounts of a hormone called beta-human chorionic gonadotropin (beta-hCG) or a protein called AFP. Increased AFP levels can also be a result of other diseases, such as hepatitis, cirrhosis, and benign liver tumors. 

Liver Function tests 

Significantly, if the cancer has advanced, the patient's liver function will undoubtedly be compromised if they have hepatoblastoma. Liver function tests record the amount of certain substances released into the blood by the liver, similar to the serum tumor marker test. If the test results show that a patient has a higher-than-normal amount of a substance than the average amount that a healthy person would have, this can indicate a strong chance that that patient has hepatoblastoma. 

Magnetic Resonance Imagining 

Magnetic resonance imaging, commonly known by its acronym, MRI, is a non-invasive to minimally invasive medical testing technique that produces detailed images of various internal structures of the body, including bones, organs, muscles, cells, and blood vessels. When using an MRI to diagnose pediatric hepatoblastoma, the MRI will use a magnet, radio waves, and a computer to make detailed images surrounding the areas around or inside the liver. To make a more detailed image of the regions of the liver when trying to diagnose hepatoblastoma or other liver cancers, gadolinium will be used for the MRI. Gadolinium is a safe substance injected into a nearby vein of the area that will be used for imaging. The gadolinium surrounds the potential cancer cells nearby, making them appear brighter in the picture.

Biopsy 

A biopsy is a procedure unique to the previous testing techniques mentioned. In a biopsy, a tissue sample is removed from a tumor that could be potentially malignant. Once the sample has been optimized, a pathologist will view the sample under a microscope. The pathologist will precisely monitor if the sample provided displays signs of being cancerous. In the same procedure, the doctor may want to remove as much of the tumor as possible. This procedure will rarely be done in a case with pediatric hepatoblastoma. Due to the anatomy of a child being smaller, it can be challenging to obtain a large enough sample to analyze without invading other essential parts of the patient’s body. 

Potential Differential Diagnosis 

In some instances, pediatric hepatoblastoma may require a differential diagnosis, a list of conditions that could cause a patient's signs and symptoms. Regarding hepatoblastoma, the following conditions would be in a differential diagnosis: hepatocellular carcinoma (HCC), focal nodular hyperplasia, hepatic adenoma, and lymphoma. Hepatocellular carcinoma is the most common hepatic cancer in adulthood and is the most common differential diagnosis for rare adult Hepatoblastoma; however, distinguishing between these two disease entities may prove difficult for the pathologist. On the other hand, Focal nodular hyperplasia primarily affects adolescents and adults. Hepatic adenoma can resemble pure fetal hepatoblastomas; however, these rarely occur in persons under five years of age unless they have an underlying metabolic disorder. With the knowledge that pediatric hepatoblastoma only affects children under five, a physician can still rule out that their patient has pediatric hepatoblastoma because the other conditions most likely would not occur at the patient's young age and stage of development. 

How Pediatric Hepatoblastoma is Staged 

Understanding the stage of cancer the patient is in is critical to knowing the correct way to treat it. Staging is the process of determining whether cancer has spread and, if so, how far. Various staging symptoms are used for hepatoblastoma. The staging method for pediatric hepatoblastoma has only been established for seven years. The Children’s Hepatic Tumors International Collaboration (CHIC) created an innovative staging and risk stratification system to standardize this tumor's assessment worldwide. In 2017, the Children’s Hepatic Tumors International Collaboration established a new staging system called the “Children’s Hepatic Tumors International Collaboration – Hepatoblastoma Stratification.” This system incorporates previously confirmed prognostic and diagnostic factors from prior risk stratification systems with advanced additional factors to stratify patients into four risk groups or stages of their hepatoblastoma. 

The most predictive factors to stage a pediatrician are AFP levels, patient age, pretreatment extent of disease, or stage (PRETEXT) group (I, II, III, or IV), the presence of metastases, and the PRETEXT annotation factor.  The PRETEXT group is based on the extent of the tumor in the liver.  The PRETEXT annotation factor is ruled out to be positive if at least 1 of the following five factors is present in the patient’s anatomy: involvement of the vena cava or all three hepatic veins, or both; participation of portal bifurcation or both right and left portal veins; extrahepatic contiguous tumor extension; multifocal hepatic tumor; and if the patient’s tumor rupture at diagnosis. Depending on the patient's hepatoblastoma stage impacts the treatment level and intensity. 

When a patient is in stage one of pediatric hepatoblastoma, that means that they will most likely have a tumor that can be completely removed with surgery, and the cancer has not spread out past the liver’s general anatomical area. When a patient is in stage two of hepatoblastoma, that means that they have a tumor that can mostly be removed by surgery, but minimal amounts of the cancer remain in the liver. In stage three of pediatric hepatoblastoma, a tumor cannot be entirely removed, and the malignant cells are found in the lymph nodes. If and when stage four of pediatric hepatoblastoma occurs, cancer has spread (metastasized) to other parts of the body. In addition to these four stages, sometimes, this cancer can be recurrent, which means that the disease has returned after it has been treated. It may come back in the liver or another part of the body. Knowing which stage a child is in with their hepatoblastoma will contribute to how their medical team conducts that treatment to make it as successful as possible without any complications or recurrences. 

How Treatment of Pediatric Hepatoblastoma is Conducted

Medical Equipment Involved in Treatment 

Before explaining how pediatric hepatoblastoma treatment is conducted, it is critical to identify the medical equipment and personnel in the patient’s care team who will conduct said treatment. The most necessary medical equipment for treating hepatoblastoma includes radiology devices such as ultrasounds, magnetic resonance imaging, or computed tomography. These imaging pieces of equipment are implemented in treatment to define the extent of tumor involvement in the liver and aid in pre-surgical planning. A chest computed tomography or CT scan can help detect lung metastasis. The lung is the most common location of metastases; up to 20% of pediatric hepatoblastoma cases have metastases. After imaging, a biopsy, alpha-fetoprotein level, liver function tests, and a hepatitis panel are performed as needed. Even though these devices have been mentioned previously as techniques to diagnose patients, they can also help identify how far a patient is in their treatment. Consent for participation in biologic studies should be requested before the biopsy is performed so the specimen can be allocated appropriately and handled. Other devices helpful in treating pediatric hepatoblastoma are surgical devices and radiation used in chemotherapy, but these procedures will be identified later in this article. 

Medical Professions that are Involved in Treatment 

Many medical professionals are involved in treating pediatric hepatoblastoma. The individual patient will receive a patient care team that will work together to conduct short- and long-term treatment for the patient because it will be a tremendous team effort to treat this complex and rare disease. Specifically, the following professions have a distinct role in treating pediatric hepatoblastoma; these professions will be described in the following sections:  general pediatricians, pediatric oncologists, pediatric surgeons, transplant surgeons, radiologists, and hepatologists. 

All of these professions listed have a similar path regarding their education. First, they will need to obtain a bachelor’s degree. While it is expected that one who desires one of these career paths will major in a degree of science, like biology or chemistry, it is not required. All one has to do is become one of the listed professions and complete all the prerequisites to attend medical school. In the third year of one bachelor’s degree, one must sign up to take the MCAT. The MCAT, or Medical College Admissions Exam, is a comprehensive standardized test used as an entrance exam for medical school. After graduating from a bachelor’s program, the next step to one of these career paths is to attend a four-year medical school (however, there are some accelerated programs where one can obtain their bachelor's degree and medical school degree in a shorter amount of time). During the third year of medical school, one must complete clinical rotations in various medical specialties, including the ones listed as a critical part of a pediatric hepatoblastoma care team. In these clinical rotations, one can decide what specialty to pursue post-graduation from medical school. In addition to declaring a specialty in medicine, one must take two national board exams, USMLE Step 1 and USMLE Step 2, before graduation. Compared to the MCAP, these standardized comprehensive exams allow students to showcase their medical school knowledge and clinical rotations. In the fourth year of medical school, one will apply for residency, where they will be trained in the specific specialty they want to pursue. When one graduates from medical school, one will obtain an M.D., which stands for Doctor of Medicine, or D.O., Doctor of Osteopathic Medicine certification. After this step in training, the careers listed as contributors to treating pediatric hepatoblastoma road to become certified in their careers become quite different. 

If one desires to become a pediatrician after medical school, one must complete a residency in pediatrics that lasts at least three years. A residency doctor's daily activities during residency include team briefings, patient rounds, performing procedures, attending lectures, and learning from seasoned doctors. The residency period is crucial in sharpening one's skills and knowledge as a pediatrician and preparing you for the challenges of the job. After completing residency, a doctor can start practicing as a fully trained doctor or attending or can complete a fellowship. In a fellowship, a pediatrician will subspecialize in a topic like pediatric oncology (oncology can be a sub-specialty in internal medicine, but if one desires to be a pediatric oncologist, undergoing a pediatric residency first will be more sufficient to one’s time in training, unless they have a passion for internal medicine and pathology that that specialty treats), and this fellowship will last three years. Once all training has been completed, a pediatrician must complete a board certification exam administered by the American Board of Pediatrics for pediatrics and potentially any subspecialty, like oncology. The average annual salary for a general pediatrician is $232,000, and for a pediatric oncologist, the average annual salary is $172,000. During treatment, a pediatric oncologist, a doctor specializing in treating children with cancer, will oversee treatment.  The pediatric oncologist works with other healthcare providers who are experts in treating children with hepatoblastoma and specialize in certain areas of medicine. It is crucial to have a pediatric surgeon with experience in liver surgery who can send patients to a liver transplant program if needed. 

Pediatric and transplant surgeons have similar training pathways. After graduating from medical school, they participate in the same residency. Aspiring pediatric and transplant surgeons complete a general surgery residency, typically lasting around five years. After residency, a doctor applies for a fellowship in either pediatrics or transplant surgery. A pediatric surgery fellowship lasts two years, and a transplant surgery fellowship lasts two years. After a fellowship, board certification exams must be obtained for general surgery and pediatric and transplant surgery subspecialties to practice independently. The average annual salary for a pediatric surgeon is $516,311, and the average salary of a transplant surgeon is $715,768. Both careers have a significant role in treating pediatric hepatoblastoma; all aspects of surgery in hepatoblastoma involve treatment, from biopsy through conventional and laparoscopic liver resections to extreme resection with adjacent structures, staged hepatectomy, and transplantation. Liver transplantation performed by transplant surgeons has an essential role in the surgical management of pediatric hepatoblastoma (HB) patients presenting with multifocal or metastatic disease. Among pediatric HB patients who received chemotherapy, there was no difference in overall survival between those who underwent liver transplant and surgical resection. In contrast, disease-free survival was better after surgical resection.

For radiologists and hepatologists, they have similar pathways to the other types of physicians. After graduating from medical school, aspiring radiologists will complete a radiology residency, lasting four to five years. Physicians who want to become hepatologists will do an internal medicine residency followed by a gastroenterology fellowship and an advanced hepatology fellowship, meaning that hepatologists train for an additional six years after graduating from medical school. As for any other physician, radiologists and hepatologists must complete a board examination for their respective fields and subspecialties. A radiologist makes an annual salary of $133,874, but this can vary depending on whether one has a subspecialty. A hepatologist makes an average yearly salary of $297,999. Even though only six professions have been outlined as a part of the care team for a pediatric hepatoblastoma case, many more health professions help provide patient treatment. Other professions include nurses, certified nurse assistants, practitioners, physiatrists, and physician associates. 

Types of Treatment 

Now that the types of medical equipment and people involved in treating pediatric hepatoblastoma have been outlined, it is imperative to outline the procedures during treatment and how they are conducted. The treatment plan for a child with hepatoma is very individualized and is decided upon by the patient’s individual care team. Specific treatment for hepatoblastoma will be determined by your child's physician based on:

the child's age, overall health and medical history, extent  and stage of the cancer, and 

The child’s tolerance for specific medications, procedures, and therapies. Treatment for hepatoblastoma is generally aimed at resecting as much of the tumor as possible while maintaining substantial liver function. It is imperative to note that liver tissue can regenerate when removed. Two types of treatment will be mentioned: surgery and chemotherapy.

The purpose of surgery is to remove any cancer that has spread to other parts of the body.

For some patients with earlier stages of liver cancer, liver transplantation may be an option.  Performed by a transplant surgeon, the surgery will entail replacing the liver with a donor's healthy liver. This liver transplantation is not a possible treatment option for every case. However, the patient’s pediatrician will discuss this option with you to see if it is a feasible treatment. If this treatment is not an option, it may be possible for surgery to be conducted where the tumor is removed from the patient's body, and a pediatric surgeon will perform this, 

The other type of treatment option that will be outlined as a method for treating pediatric cancer will be chemotherapy. Chemotherapy uses drugs to kill malignant cells. 

The patient may receive chemotherapy before surgery to help reduce the size of the liver cancer or, after surgery, kill any remaining cells. Chemotherapy is also given after surgery when the doctor has removed the hepatoblastoma; it is called adjuvant chemotherapy. 

Chemotherapy for childhood liver cancer is usually put into the body through a needle in a vein or artery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, moves throughout the body, and can eliminate malignant cells outside the liver. In another variation of chemotherapy, direct infusion chemotherapy, drugs are injected directly into the blood vessels that go into the liver. In addition to the previous treatments, there is yet another variation of treatment, especially for pediatric liver cancer. A special treatment called chemo-embolization is sometimes used to treat liver cancer in children. Chemotherapy drugs are injected into the main artery of the liver with substances that block or slow the flow of blood into the tumor. This will lengthen the chemotherapy time to kill the malignant cells and prevent cancer cells from getting the oxygen and nutrients they need to expand and develop through the body. 

Potential Complications of the Treatment 

Although these treatments have proven to help cure and stop the recurrences of hepatoblastoma in children, there still are compilations that have occurred when cases have received treatment. There are the most complications when a liver transplant treats pediatric hepatoblastoma. According to the National Library of Medicine, An increased risk of post-transplant lymphoproliferative disorder after immunosuppression for liver transplant has been suggested in some publications. Other complications occurring in treatments meant to cure pediatric hepatoblastoma include the following: intraperitoneal tumor ruptures, complications related to chemotherapy, post-transplant complications, and psychosocial effects of treatment and painful procedures. 

Past Treatments for Pediatric Hepatoblastoma and Future Advancements 

Even though treatment methods for pediatric hepatoblastoma can still improve, which will happen as research in the disease advances, the treatment methods for this rare type of cancer have advanced tremendously in recent years. According to the National Library of Medicine, Before 1980, children with malignant hepatic cancer, including hepatoblastoma, could only be cured by complete surgical resection of tumors. In present treatment methods, complete tumor resection remains the primary treatment procedure (along with chemotherapy) for a definitive cure for hepatoblastoma, and the process of treatment offers the only realistic chance of long-term disease-free survival. The introduction of effective chemotherapeutic regimens in the 1980s resulted in a broader range of patients who could ultimately undergo tumor resection. Chemotherapy also reduces the postoperative recurrence rate of cancer cells. 

Moreover, modern surgical techniques based on the segmental anatomy of the liver and whole hepatectomy have also led to increased numbers of resectable patients and have markedly improved the prognosis of these patients.  Recently, international collaboration studies by scientists in Japan, America, and Germany have been conducted to advance pediatric hepatoblastoma cases further, and they are currently undergoing clinical trials to advance current treatments. Moreover, the survival rate for hepatoblastoma is more than 80% if the tumor is only in the liver and can be removed entirely with surgery after chemotherapy.

Survival rates for children whose tumors involve the entire liver or have spread outside the liver range from 20%. The survival rate rises to 70% 3–5 years after diagnosis.

Vital Statistics Regarding Pediatric Hepatoblastoma 

The last topic essential to overview when understanding the complexities of pediatrics is vital statistics related to this disease. Specifically, it is necessary to understand statistics regarding the cases diagnosed with pediatric hepatoblastoma. According to Cancer.gov, in the United States, approximately 50 to 125 cases of hepatoblastoma, a rare pediatric liver cancer, are diagnosed each year, and this number has decreased in recent years. For example, in  2019, there were an estimated 100 to 125 cases that were diagnosed with pediatric hepatoblastoma. Comparative to the year 2022, when only 50 to 70 cases were diagnosed with this disease. Once again, hepatoblastoma occurs in about 1 to 2 children per million; 95% of cases are diagnosed before the age of 4 and never happens for children in later childhood (it is probably another variation of hepatic cancer). Hepatoblastoma is the most common primary malignant liver tumor in children, accounting for about 2/3 of primary hepatic tumors and 0.5–2% of all pediatric tumors. Another vital statistic to mention is about the chances of cancer recurring post-treatment for hepatoblastoma in children. According to the Children’s Hospital of Pittsburgh, Up to 80 percent of cases that are treated with hepatic transplantation survive longer than 20 years without experiencing recurrences, if the tumor is confined to the liver.  Recurrences can occur in 16 percent of children after transplantation. Malignant cell recurrence is most common during the first twenty-four months of treatment and seldom occurs afterward. Hepatoblastoma most commonly spreads to the lungs, especially in pediatric cases. 

Discussion

Before a recap of the information concerning pediatric hepatoblastoma, why it is the first topic of this research needs to be explained. Pediatric hepatoblastoma is a sufficient research topic because it is a rare form of pediatric cancer. When the general public envisions pediatric cancer, their minds are quick to associate that topic with diseases like breast cancer or leukemia. Although these diseases need more research to advance in healthcare, it is equally as essential to address types of cancers that most people will never familiarize themselves with, let alone someone who is diagnosed with this treatment. Before this research was conducted, the author had very little knowledge of liver cancer and did not know about hepatoblastoma. Especially for aspiring personnel in the medical or scientific fields, familiarizing oneself with every type of cancer, their origins, and how the treatment for said cancers are conducted will be critical to know as a part of one’s education, and one should familiarize oneself with these complex topics as soon as possible. 

Conclusion 

Now, by understanding the complexities of this disease and the past and curating treatment methods, one can immerse themselves in the rare diseases of pediatric hepatoblastoma. By understanding that hepatoblastoma only accounts for once percent of pediatric cancer cases worldwide, one can understand that research on this topic seldom occurs by medical personnel and that this research will recap all of this disease's past, present, and future research. To start this research off, the foundation for understanding pediatric hepatoblastoma was established by identifying how cancer forms in the body and the risk factors for why children can be potentially at risk for developing this disease. Following this, it was determined the signs and symptoms to look out for if hepatoblastoma is present in a child, the methods used to diagnose the disease properly, and how to rule out the disease is hepatoblastoma and not another type of hepatic cancer. Then, it was explained how the treatment is conducted for pediatric hepatoblastoma cases, including types of medical equipment, medical personnel, and the treatment procedures involved. Lastly, it was mentioned how these treatments would continue to improve, as well as the statistics involved with the cases and success of the treatment of hepatoblastoma. Hepatoblastoma and its treatment impact children incredibly during their development. In general, there may be problems with the heart, kidneys, nerves, or hearing from the most common chemotherapy used to treat liver tumors. In addition to this, children might have long-lasting trauma and mental illness as a result of fighting for their lives while undergoing treatment. Due to a large number of people being unaware of this type of pediatric cancer, there are many ways that one can raise awareness about this disease, especially among the youth. Methods in which to spread awareness of this disease include the following: conducting and publishing research on this topic, upholding content on social media that outlines the basic facts about pediatric hepatoblastoma, creating a fundraiser for the disease, and then donating it to a local hospital, etc. Overall, pediatric hepatoblastoma is a unique type of cancer that has been shown to present in pediatric cases, and this disease requires more advances to save the lives of more positively tested children in the upcoming years; anyone can play a part in the disease’s advancement. 

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