A 4 -year old boy after being seen by multiple doctors, who were unable to put their fingers on a particular diagnosis was finally diagnosed with liver cancer by doctors at Wockhardt Hospitalm Mumbai.


 

The boy, a resident of Silvassa presented with features of poor weight gain, fever, jaundice. He was later seen and thoroughly evaluated by Dr Lalit Verma Paediatric Gastroenterology and Hepatologist in Wockhardt Hospital, Mira Road who found that there was significant abdominal distension with a mass suspecting it to be a tumour. By using clinical judgement, diagnostic tool like CT scan and blood markers, Dr Verma diagnosed this large liver mass as Hepatoblastoma. It is a rare tumor cancer of liver which can present even in 1st month of life.

An official release by Wockhardt today stated Later Dr Akansha (Pediatric oncologist) also came on board and jointly it was decided to start patient on chemotherapy (6 cycles). Once the cycles were over a repeat CT scan was done which showed significant reduction in tumour size. At this point, Dr Krutarth (adult onco-surgeon) and Dr Kant (Pediatric onco-surgeon) were involved for the excision of tumor mass.

This surgery demands a very challenging anesthesia management as malignancies are rare in this age group, and the surgery is extensive in an already compromised child. The child was taken up as a high risk case under balanced general anesthesia along with epidural analgesia and invasive pressure monitoring. Intra operative, medicines which are safe for liver cases were given and blood loss was replaced with blood and blood factors.

The child was shifted to the pediatric ICU where he was managed by Dr Rushil. Dr Lalit Verma, Paediatric Gastroenterology and Hepatologist from Wockhardt Hospital, Mira Road said, Liver surgery is a challenging task. One has to plan the whole surgery mentally first looking at CT scans in three dimensions as the anatomy of liver is very variable in all individuals.

Giving anesthesia involves not only keeping patient asleep for 6-8 hours but also monitor the blood pressure, clotting factors, blood gases and such parameters very closely. It is like running an ICU inside the operation theatre. The surgery itself has to be very precise to minimize damage to the normal liver which will be left behind after removing the large tumour. The tumour in Jastik’s case was initially involving almost 3/4th of his liver. After receiving 7 planned cycles of chemotherapy it had shrunk to involve just over half of the liver.

Fortunately the tumour was removed in total with adequate margin of normal tissue. The residual liver has shown normal biochemical function and we expect it to grow to an almost normal size. He will receive three further chemotherapy cycles and we hope he has long term remission and cure. Presently Jastik is stable, with astoma bag. He is getting discharged with the same. Plan is to bring him back for 3 chemo cycles.