The Cures for Neuroblastoma

Neuroblastoma is cancer that begins early in fetal development in the nerves of the sympathetic nervous system. As the second most common form of cancer in children, it is usually diagnosed before the age of 2. Neuroblastoma can be cured if it is diagnosed and treated before extensively spreading.

Definition

• The sympathetic nervous system controls smooth muscles that we do not consciously control. This includes the heart, glands, organs and blood vessels, in addition to areas in the abdomen where the nerves meet and communicate with one another called nerve ganglia. More than a third originate in the adrenal glands although they can begin anywhere in the body. They start during fetal development when some of the nerves do not grow normally. If the immature nerve cells are still present after birth, they can clump together and form a mass that becomes cancerous.

  The signs and symptoms depend on where the tumor is located and whether it has spread. The earliest symptom is usually a lump, followed by swelling in the face, throat, or legs as the tumor grows.

Prognosis

• The prognosis, or the chance of a cure and recovery, depends on several different factors. The child's age at the time of diagnosis is important because the older the child, the longer the tumor has had to spread. Other factors are where the tumor is located in the body (this affects the ability to surgically remove the cancer), how fast the tumor cells are growing and the stage of the cancer.

Stage

• Tests must be done to determine if it has spread, and if so, how extensively. The tests include a biopsy, CAT scan, magnetic resonance imaging (MRI), X-rays and ultrasound. Tissue from the biopsy will be used to grade what the cells look like (this indicates how fast the tumor is growing), gain information about the genes in the tumor, and whether it has begun to spread. The other procedures are used to visualize the tumor and see how far it has spread. All the information will be used to determine the stage of the disease, and the stage will impact the potential cure. Neuroblastomas can be assigned to four different stages that are based on whether the tumor has spread and how much of it was removed during surgery. The stages are further categorized as low, intermediate or high risk. The low and intermediate risk tumors have a good chance of being cured. The high risk tumors are difficult to cure.

Treatment

• The treatment options are determined according to stage and risk group. There are three standard treatments: Surgery, radiation therapy and chemotherapy. Surgery is used to remove as much of the cancer as possible. Radiation and chemotherapy kill any remaining tumor cells but radiation does that through X-rays and chemotherapy uses drugs.

  Children in the low-risk category usually only require surgery to remove the entire tumor. Then the treatment consists of careful monitoring to be sure the cancer is gone. Chemotherapy may be needed if less than half the tumor was removed. Neuroblastomas graded as intermediate risk need surgery followed by 12 to 24 weeks of chemotherapy, and then radiation therapy if chemotherapy doesn't work. The high risk category demands aggressive treatment that usually includes all three treatments and sometimes a stem cell transplant.

Clinical Trials

• Research is always ongoing to find better treatments. Some possible cures being studied are monoclonal antibody therapy, high-dose chemotherapy with stem cell transplant and new drugs that slow the growth of the cancer cells. If you're interested in participating in a clinical trial, ask your pediatric oncologist or use the ClinicalTrials.gov website to locate studies that are recruiting participants. (See Resources section of this article.)