Neuroblastoma - Children

Neuroblastoma - Children

Overview

Neuroblastoma is a cancer that starts in cells called neuroblasts. Neuroblasts are immature nerve cells. They are found in several areas of the body.

Neuroblastoma most often starts in the neuroblasts in the adrenal glands. The adrenal glands are located on top of each kidney. The glands make hormones that control important functions in the body. Other parts of the body that have neuroblasts and can get neuroblastoma include the spine, belly, chest and neck.

Neuroblastoma usually affects children age 5 or younger. Symptoms vary, depending on where it occurs in the body.

Some forms of neuroblastoma may go away on their own. Other forms of neuroblastoma need treatment. Treatments include surgery, chemotherapy, radiation therapy and bone marrow transplant. Your child's healthcare team will select the neuroblastoma treatments that are best for your child.

Symptoms

Signs and symptoms of neuroblastoma may vary depending on what part of the body is affected. This cancer starts in immature nerve cells called neuroblasts. Neuroblasts are found in several areas of the body.

Neuroblastoma in the belly may cause symptoms such as:

Belly pain.

A lump under the skin that typically isn't tender when touched.

Diarrhea or constipation.

Neuroblastoma in the chest may cause symptoms such as:

Wheezing.

Difficulty breathing.

Changes to the eyes, including drooping eyelids and pupils that are different sizes.

Other symptoms that may indicate neuroblastoma include:

Lumps of tissue under the skin.

Eyeballs that seem to stick out from the sockets.

Dark circles around the eyes that look like bruises.

Back pain.

Fever.

Losing weight without trying.

Bone pain.

Causes

It's not clear what causes neuroblastoma. This cancer starts in immature nerve cells called neuroblasts. Neuroblasts are found in several areas of the body.

Neuroblastoma starts when neuroblasts develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

The risk of neuroblastoma is higher in children. This cancer happens mostly in children age 5 and younger.

Children with a family history of neuroblastoma may be more likely to develop the disease. Yet, healthcare professionals think only a small number of neuroblastomas are inherited.

There are no known ways to prevent neuroblastoma.

Complications

Complications of neuroblastoma may include:

Spread of the cancer. With time, the cancer cells may spread to other parts of the body. Neuroblastoma cells most often spread to the lymph nodes, bone marrow, liver, skin and bones. When cancer spreads, it's called metastatic cancer.

Pressure on the spinal cord. A neuroblastoma may grow and press on the spinal cord, causing spinal cord compression. Spinal cord compression may cause pain and paralysis.

Symptoms caused by cancer secretions. Neuroblastoma cells may secrete chemicals that irritate other tissues. The irritated tissues can cause symptoms called paraneoplastic syndromes. Symptoms of paraneoplastic syndromes may include rapid eye movements and difficulty with coordination. Other symptoms include abdominal swelling and diarrhea.

Diagnosis

A neuroblastoma diagnosis might start with a physical exam. Other tests and procedures include imaging tests and removing some tissue for testing. Your child's healthcare team may use a variety of tests and procedures to diagnose this cancer.

Physical exam

A healthcare professional may examine your child to check for signs of neuroblastoma. The healthcare professional may ask you questions about your child's symptoms and health history.

Urine and blood tests

A healthcare professional might test your child's urine and blood. The results can help the healthcare professional better understand your child's condition. Urine tests might look for high levels of chemicals made by neuroblastoma cells. For example, neuroblastoma can produce chemicals called catecholamines. These might be detected by a urine test.

Imaging tests

Imaging tests make pictures of the body. They may help your child's healthcare team find the location of neuroblastoma and look for signs that it may have spread.

Imaging tests for neuroblastoma may include:

X-ray.

Ultrasound.

Computerized tomography scan, also called CT scan.

Magnetic resonance imaging, also called MRI.

Metaiodobenzylguanidine scan, also called MIBG scan.

Not everyone needs each test. The healthcare team will decide which tests are needed based on your child's condition.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the sample, a healthcare professional might put a hollow needle through the skin and into the cancer. The health professional uses the needle to draw out some cells for testing. Sometimes a surgeon removes the tissue sample during surgery.

In the lab, tests can check the tissue for signs of cancer. Other tests might look for changes in the DNA inside the cancer cells. Results from these tests may help your child's healthcare team make a treatment plan.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy are procedures that involve collecting cells from the bone marrow. The cells are sent for testing. These procedures are used to check if neuroblastoma has spread to the bone marrow.

Bone marrow is the soft matter inside bones where blood cells are made. Bone marrow has a solid part and a liquid part. In a bone marrow aspiration, a needle is used to draw a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. The samples are typically taken from the hip bone.

Neuroblastoma stages

The healthcare team uses the results from these tests to give the neuroblastoma a stage. The stage tells the healthcare team about the prognosis and helps the team create a treatment plan.

The stages of neuroblastoma are:

L1. This stage means the neuroblastoma is growing in one area. The caner doesn't involve any structures that would make it hard to remove the cancer completely with surgery.

L2. This stage means the neuroblastoma is growing in one area. However, the cancer involves structures that might make it hard to remove all the cancer with surgery.

M. This stage means the neuroblastoma has spread to other parts of the body.

MS. This stage applies to children younger than 18 months. It means the neuroblastoma has spread to the skin, liver or bone marrow.

Treatment

Treatments for neuroblastoma include surgery, radiation therapy, and medicines, such as chemotherapy and others. Healthcare teams consider many things when creating a treatment plan. These include the child's age, the stage of the cancer, the kinds of cells involved in the cancer and the DNA changes inside the cancer cells.

The healthcare team uses this information to say whether the neuroblastoma is low risk, intermediate risk or high risk. Neuroblastoma that is low risk or intermediate risk has a good chance for cure. High risk neuroblastoma can be more difficult to cure, so stronger treatments might be needed. What treatment or combination of treatments your child receives for neuroblastoma depends on the risk category.

Surgery

During surgery for neuroblastoma, surgeons use cutting tools to remove the cancer cells. In children with low-risk neuroblastoma, surgery to remove the cancer may be the only treatment needed.

Whether the cancer can be removed completely depends on its location and size. Cancers that are attached to nearby vital organs may be too risky to remove.

In intermediate-risk and high-risk neuroblastoma, surgeons may try to remove as much of the cancer as possible. Other treatments, such as chemotherapy and radiation therapy, may then be used to kill remaining cancer cells.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form.

Children with intermediate-risk neuroblastoma often receive a combination of chemotherapy medicines before surgery. This improves the chances that the entire cancer can be removed.

Children with high-risk neuroblastoma often receive high doses of chemotherapy medicines to shrink the cancer. Chemotherapy also helps kill any cancer cells that have spread to other parts in the body. Chemotherapy often is used before surgery and before bone marrow transplant.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Children with high-risk neuroblastoma may receive radiation therapy after chemotherapy and surgery. The radiation can help lower the risk that the cancer will come back.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments.

A bone marrow transplant might be an option for children with high-risk neuroblastoma. A bone marrow transplant for neuroblastoma uses the child's own blood stem cells. This kind of transplant is called an autologous stem cell transplant.

Before the transplant, a procedure is done to filter and collect blood stem cells from the child's blood. The stem cells are stored for later use. Next, the child receives high doses of chemotherapy to kill any remaining cancer cells. Then the blood stem cells are put back into the child's body. The transplanted cells can form new, healthy blood cells.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy is sometimes used with chemotherapy for high-risk neuroblastoma.

Type of Doctor Department : Pediatric oncologist or a pediatric hematologist/oncologist