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What is neuroblastoma in children?
Neuroblastoma is a cancerous tumor. It grows in nerve tissue of babies and young children.
The cancer cells grow in young nerve cells of a baby growing in the womb. These cells
are called neuroblasts. It’s is the most common cancer in babies under age 1. It’s rare
in children older than age 10.
- Nerve fibers along the spinal cord
- Clusters of nerve cells (ganglia) along the nerve fibers
- Nerve-like cells in the adrenal glands
In most cases, neuroblastoma starts in the adrenal glands or the nerve fibers in the
abdomen. Other common places for it to grow include the nerve fibers near the spine
in the chest, neck, or lower belly (pelvis).
What causes neuroblastoma in a child?The cancer is caused by changes in the DNA of the cells. In most children, this happens
by chance. A small number of children inherit the risk from their parents.
What are the symptoms of neuroblastoma in a child?
The symptoms vary depending on the size and location of the tumor and if it has spread.
Symptoms can also occur a bit differently in each child.
Symptoms of a tumor in the belly (abdomen) can include:
- A lump in the abdomen
- Swelling in the abdomen
- Loss of appetite
- Weight loss
- Swelling of the legs
- Swelling of the scrotum
- Feeling full
Symptoms of a tumor in the chest can include:
- A lump in the chest
- Swelling in the face, neck, arms, or chest
- A change in mental state
- Coughing or trouble breathing
- Trouble swallowing
- Drooping eye lids and other eye changes
- Changes in feeling or movement of the arms or legs
Symptoms of a neuroblastoma that has spread to other parts of the body can include:
- Enlarged lymph nodes
- Bone pain or limping
- Weakness, numbness, or inability to move arms or legs
- Bruising around the eyes
- Bulging eyes
- Lumps on the head
- Feeling tired or weak
- Frequent infections
- Easy bruising or bleeding
A neuroblastoma may release hormones. This is called paraneoplastic syndrome. It can
cause symptoms such as:
- Constant diarrhea
- High blood pressure
- Fast heart rate
- Flushing or redness of skin
A neuroblastoma can also cause opsoclonus-myoclonus-ataxia syndrome. This can lead
to symptoms such as:
- Quick eye movements
- Muscle twitching
- Trouble with coordination
The symptoms of neuroblastoma can be like other health conditions. Make sure your
child sees a healthcare provider for a diagnosis.
How is neuroblastoma diagnosed in a child?
You may take your child to the healthcare provider because of a lump, swelling, or
other symptoms. Most of the time, neuroblastoma has spread by the time it is diagnosed.
Your child's healthcare provider will ask about your child's medical history and symptoms.
He or she will examine your child. Your child may be referred to a specialist in diagnosing
and treating cancer in children (pediatric oncologist).Your child may have tests such
- Blood and urine tests. Blood tests check for signs of disease in the body. Your child may also have urine
and blood tests to check for hormones released by the tumor.
- Ultrasound exam (US). Sound waves and a computer are used to create images. An ultrasound may be done to
check your child's belly (abdomen), kidneys, or to guide a needle in a biopsy
- X-ray. X-rays may be done to check your child's chest or bones
- CT scan. X-rays and a computer are used to make images of the body. Scans of the belly (abdomen),
lower belly (pelvis), or chest may be done. Contrast dye may be used. A CT scan may
also be used to guide the needle in a biopsy.
- MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the
body. This test is used to check the brain and spinal cord.
- Bone scans. A small amount of dye is injected into a vein. The whole body is scanned. The dye
shows up in areas of bone where there may be cancer.
- Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells
use more sugar than normal cells, so the sugar will collect in cancer cells. A special
camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes
spot cancer cells in different areas of the body, even when they can’t be seen by
other tests. This test is often used in combination with a CT scan. This is called
a PET/CT scan.
- Metaiodobenzylguanidine (MIBG) scan. A small amount of radioactive iodine called MIBG is injected into a vein. The dye travels
through the blood and attaches to cancer cells. Scans may be taken over a few days.
- Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small
amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone
marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from
the pelvic bone. This test may be done to see if cancer cells have reached the bone
- Tumor biopsy. A sample of the tumor is taken. It may be taken with a needle or by a surgical cut
(incision). It is checked under a microscope for cancer cells. A biopsy is needed
to diagnose neuroblastoma.
Staging and grading of neuroblastoma
Once neuroblastoma has been diagnosed, a stage is assigned. Staging is the process
of seeing if the cancer has spread, and where it has spread. Staging also helps to
decide the treatment. Doctors use two different staging systems for neuroblastoma:
the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma
Risk Group Staging System (INRGSS).
The INSS system divides tumors into stages 1 through 4. It’s assigned after surgery
has been done to remove the tumor. Stage 1 is early cancer. It's only in the place
where it started and only on one side of the body. For neuroblastoma, this means the
tumor can be fully seen and removed by surgery. Stages 2 and 3 are more complex. The
tumor is harder to remove and cancer cells may have spread. Stage 4 means cancer cells
from the tumor have spread to other parts of the body far from the primary tumor.
The INRGSS system divides tumors into 4 stages labeled L1, L2. M, and MS. Surgery
does not need to be done before assigning one of these stages. They are based on how
the tumor looks based on scans called image-defined risk factors (IDRFs) and biopsies.
They are used to predict how much of the tumor can be taken put with surgery. The
L groups means the cancer is confined to one part of the body. The M group means it
has spread beyond where it first started to distant organs. MS is used in children
younger than 18 months with cancer that has spread only to the skin, liver, or less
than 10% of the bone marrow, or all three.
Grading is used to describe how abnormal the cancer cells look when seen through a
microscope. The more abnormal the cells are, the faster they grow. Staging and grading
help the healthcare team plan treatment for your child.
Other factors considered
The healthcare team also looks at:
- The location of the main tumor
- Genetic changes in the tumor cells
- The age of your child
Your child’s healthcare team will tell you more about the stage and grade of your
child’s cancer. The stages of neuroblastoma are very complex. Be sure to ask the healthcare
provider to explain the stage of your child's cancer to you in a way you can understand.
Also be sure to ask the healthcare provider if you have any questions.
How is neuroblastoma treated in a child?
Treatment will depend on the stage and other factors. The cancer can be treated with
any of the below:
- Surgery. Surgery is often done to remove as much of the tumor as possible (resection). Surgery
may not be possible if the cancer has spread.
- Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be
given into the vein (IV), injected into tissue, or taken by mouth. They may be given
before or after surgery. Or they may be the main treatment if surgery is not possible.
The medicine is given in cycles, with rest periods in between.
- Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer
cells or stop them from growing. Radiation may be outside of the body (external) or
inside the body (internal). Radioactive iodine (MIBG) is given into a vein (IV). Your
child will stay in the hospital for this treatment.
- High-dose chemotherapy/radiation with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This
is followed by a large amount of chemotherapy medicine and/or radiation. This causes
damage to the bone marrow. After the chemotherapy or radiation, your child will get
stem cells to renew the bone marrow.
- Immunotherapy. This treatment helps the body's immune system attack cancer cells. It is also used
when there is a high risk of cancer returning.
- Retinoid therapy. Retinoid medicine may be given after high-dose chemotherapy/radiation and stem cell
transplant. It may be used when there is a high risk of cancer returning. It will
reduce the chance of relapse or recurrence.
- Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for
pain, fever, infection, and nausea and vomiting.
- Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that
may work well for your child.
With any cancer, how well a child is expected to recover (prognosis) varies. Keep
- Getting medical treatment right away is important for the best prognosis.
- Ongoing follow-up care during and after treatment is needed.
- New treatments are being tested to improve outcome and to lessen side effects.
What are the possible complications of neuroblastoma in a child?
A child may have complications from the tumor or from treatment, such as:
- Bleeding or infection after surgery
- Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising
and bleeding, and feeling tired from chemotherapy
- Burns, hair loss, and feeling tired from radiation
- Nausea and diarrhea from radiation to the belly (abdomen)
- Problems with growth and development
- Heart and lung problems
- Changes in sexual development
- Problems with the ability to have children (fertility) in the future
- Return of the cancer
- Growth of other cancers
- A high risk of serious bleeding (consumption coagulopathy) (rare)
How can I help my child live with a neuroblastoma?
A child with a neuroblastoma needs ongoing care. Your child will be seen by oncologists
and other healthcare providers to treat any late effects of treatment and to watch
for signs or symptoms of the tumor returning. Your child will be checked with imaging
tests and other tests. And your child may see other healthcare providers for problems
from the tumor or from treatment. Your child may need therapy to help with movement
and muscle strength. This may be done by physical and occupational therapists.
You can help your child manage his or her treatment in many ways. For example:
- Your child may have trouble eating. A dietitian may be able to help.
- Your child may be very tired. He or she will need to balance rest and activity. Encourage
your child to be active. This is good for overall health. And it may help to lessen
- Get emotional support for your child. Find a counselor or child support group can
- Make sure your child attends all follow-up appointments.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
Key points about neuroblastoma in children
- Neuroblastoma is a cancerous (malignant) tumor that begins in nerve tissue of infants
and very young children.
- The symptoms of neuroblastoma vary greatly depending on size, location of the tumor and
whether it has spread. Common symptoms are a lump or swelling.
- Neuroblastoma is diagnosed with blood and urine tests, imaging tests, and biopsy.
- Treatment of neuroblastoma may include surgery, chemotherapy, radiation therapy, high-dose
chemotherapy/radiation with stem cell transplant, and other medicines.
- Continuous follow-up care during and after treatment is necessary
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.
Online Medical Reviewers:
- LoCicero, Richard, MD
- Stump-Sutliff, Kim, RN, MSN, AOCNS