Neuroblastoma

Neuroblastoma is a type of cancer that starts in children, sometimes even before birth. Cancer is when cells grow out of control, join together, and form a tumor. Neuroblastoma tumors start in cells in a child's nerves. The cancer can spread quickly to other parts of the body. The cancer can follow the nerves that run down the spinal cord and branch out into the body. Neuroblastoma tumors can be found anywhere in the child's body that these branches go. Most often, tumors are found in the abdomen, the glands that make hormones, and on top of the kidneys (adrenal glands).

CAUSES

It is not known what causes neuroblastoma. It may be caused by nervous system development before birth. It also may be passed from one generation to the next (genetic).

SYMPTOMS

Symptoms of neuroblastoma vary. The size and location of the tumor make a difference. Whether the cancer has spread also affects symptoms. Possible symptoms include:

  • Swelling of the abdomen.

  • Abdominal pain.

  • Bone pain.

  • Limping.

  • Being unable to walk or to use an arm or leg.

  • Swelling and bruising around the eyes.

  • Trouble breathing.

  • Trouble urinating.

  • Diarrhea.

  • Pale skin.

  • Fever.

  • Not wanting to eat.

  • Not gaining weight.

  • High blood pressure.

  • A heartbeat that is faster than normal.

  • Feeling more tired than usual.

DIAGNOSIS

Children are usually diagnosed with this cancer when they are about 9 months old. A caregiver will use a variety of ways to decide if a child has neuroblastoma. They may include:

  • A physical examination.

  • Blood tests.

  • Imaging tests.

  • Other procedures, such as bone marrow aspiration, lumbar punctures, and biopsies.

The results of all tests and exams are studied. That information can help figure out if the cancer has spread. It can also help decide what treatments might be best. This process is called staging. The stages for neuroblastoma are:

  • Stage 1. The tumor is in only one part of the child's body. It can be completely removed by surgery.

  • Stage 2. The tumor cannot be completely removed by surgery. Or, it has spread to the small groups of cells that help fight infection (lymph nodes) on one side of the body.

  • Stage 3. The tumor has spread to lymph nodes on the other side of the body.

  • Stage 4. The tumor has spread to other parts of the body, such as bones or the liver.

TREATMENT

Neuroblastoma can be treated in many ways. Cancer-fighting drugs (chemotherapy) are often used. Surgery may be an option. Another type of treatment is called immunotherapy. It uses drugs that help the body's own defense system (immune system) fight the cancer.

The best treatment for a child will depend on:

  • The stage of the tumor.

  • The child's age.

  • The child's health overall.

  • The preferences of the child's parents or guardians.

  • The opinion of the child's caregivers and cancer specialists.

Most children are treated with a combination chemotherapy and surgery. Some children also need treatment with high-energy rays that kill or shrink tumors (radiation therapy).

  • In stage 1 neuroblastoma, all of the tumor can usually be taken out in surgery.

  • Surgery is also used to remove tumors that have been made smaller by chemotherapy or radiation.

  • Chemotherapy can kill cancer cells, but it also affects normal cells. It can have many side effects.

  • Stem cell transplantation may be used for stage 3 or 4 neuroblastoma. High doses of chemotherapy are given to kill cancer cells. Sometimes radiation is given too. Then, young cells that were taken earlier from the child's bone marrow (stem cells) are put back in the child's body. These should then make new, healthy cells.

  • New treatments also are being developed. One possible treatment combines a variety of drugs. The combination includes a drug made from vitamin A that kills rapidly dividing cells (isotretinoin), a a man-made protein (monoclonal antibody) and two substances made by the immune system (cytokines).

HOME CARE INSTRUCTIONS

  • What children with neuroblastoma need varies greatly from child to child. Talk to your child's caregivers about what to expect. It will depend on:

  • Your child's age.

  • Your child's health.

  • The stage of their disease.

  • The treatment they were given.

  • Parents or guardians should learn as much as possible about neuroblastoma. This can help when treatment decisions need to be made. It also will let you know what to expect.

  • Most treatments last about 9 months. Each month, your child may have to stay in the hospital for about a week. Treatment will be given at the hospital. Tests will also be done at the hospital.

  • Make sure the child goes to all follow-up appointments. Every child with neuroblastoma needs to see caregivers every so often for several years. This will include visits to cancer specialists and other caregivers. This lets them keep track of how the child is doing. It also lets them spot a problem quickly if one develops.

SEEK MEDICAL CARE IF:

  • Any symptoms come back.

  • The child develops diarrhea, throwing up (vomiting), or abdominal pain.

  • The child seems weak or more tired than usual.

  • The child is not gaining weight.

SEEK IMMEDIATE MEDICAL CARE IF:

  • The child's diarrhea, vomiting, or abdominal pain does not go away.

  • The child has bleeding that does not stop.

  • The child has trouble breathing.

  • The child develops a fever of more than 100.5° F (38.1° C).