Neuroblastoma in Children

Neuroblastoma, which starts in immature nerve cells, is the most common cancer in infancy, and accounts for 8 to 10 percent of all childhood cancers, according to the National Cancer Institute. The NCI goes on to report that neuroblastoma usually begins in the nerve tissue of the adrenal glands, which sit on top of the kidneys. The adrenal glands produce hormones that help regulate our body's processes like heart rate and blood pressure . It can also start in the chest, abdomen or in nerve tissue in the neck, near the spine.

Symptoms

• As with many cancers, neuroblastoma does not always have symptoms in the early stages of the disease. It is usually found when the tumor is affecting nearby tissues or the bones, says the NCI. For this reason, it has often metastasized by the time it is diagnosed.

  Symptoms of neuroblastoma include a lump in the abdomen, chest, or neck, bulging eyes, fever, fatigue, and in infants, bluish lumps under the skin. These symptoms can also be indicative of other diseases or problems, and a doctor needs to examine the patient and do the appropriate tests to ensure a proper diagnosis.

Diagnosis

• The first thing a physician will do is perform a physical exam to look for any signs and symptoms. Various laboratory tests might be ordered, like a 24-hour urine test and blood chemistry tests. X-rays, a CT scan, an ultrasound, and a neurological exam are also common diagnostic tools, according to the NCI. A bone marrow biopsy is done so that pathologists can examine the bone marrow, bone and blood for any cancer.

Prognosis

• When a child gets a diagnosis of neuroblastoma, one of the first things parents wonder is what the child's prognosis is. Both prognosis and treatment depend on various factors. The age of the child at diagnosis, the location of the tumor in the body, the stage of the cancer and the tumor cell characteristics are all things that physicians look at when determining a prognosis, according to the NCI. Tumor biology also helps determine prognosis. This includes the rate of growth of the tumor cells, how different the cancer cells are from the normal ones, and patterns of the cancer cells. The tumor biology is separated into favorable or unfavorable types, with the unfavorable types having a worse prognosis.

Treatment and Late Effects

• Four types of treatment are generally used in treating neuroblastoma: surgery, radiation, chemotherapy and watchful waiting, says the NCI. Bone marrow transplantation has also been used to treat neuroblastoma, according to the Children's Cancer Research Fund. Depending on the stage of the disease, different combinations of these treatments may be used. The stages of neuroblastoma may also be further classified into risk groups, and treatment follows accordingly. These risk groups are low-risk, intermediate-risk and high-risk, says the NCI. Low- and intermediate-risk cancers are easier to cure than high-risk ones.

  Follow-up tests may be done to monitor the response to treatment, and even years later, follow-up care is performed to make sure the child's health has not changed and also to look for late effects. Some cancer treatments can have side effects many years later, and include second cancers, mood changes and physical problems. Because this is a major concern for many parents and doctors, this should be discussed with your physician.

Future Directions

• Clinical trials for neuroblastoma include targeted therapy, which are drugs that only target the cancer cells, and not the normal cells, thereby alleviating many side effects and late effects, high-dose chemotherapy and radiation with a stem cell transplant and the use of a drug called 13-cis retinoic acid,according to the NCI. This drug is may slow the cancer's reproduction.