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Neuroblastoma is a rare type of cancer that develops from the immature nerve cells. It is commonly found around the adrenal glands (located at the top of the kidneys). Its function is to regulate the body’s metabolism, blood pressure, the body’s response to stress, and other functions at the body. Neuroblastoma could also develop in other organs of the body that have these nerve cells including spinal cord, abdomen, chest, and others. Neuroblastoma usually affects children 5 years old and below. Treatment options usually are surgery, chemotherapy, radiation therapy, bone marrow transplant, and immunotherapy.
Symptoms
Signs and symptoms of neuroblastoma depend on the location of the tumor and the stage of the disease.
Symptoms of neuroblastoma in the abdomen can include:
- Lump or swelling in the abdomen
- Abdominal pain
- Bowel habit changes
- Leg swelling
- Loss of appetite
Symptoms of neuroblastoma in the chest can include:
- Swelling in the face, neck, arms, and upper chest
- Headache
- Dizziness
- Cough or trouble breathing
- Drooping eye lids
Symptoms of neuroblastoma that spread to other parts of the body can include:
- Bulging eyes
- Weakness
- Inability to move arms or legs
- Bone pain
- Unexplained weight loss
If you notice any signs and symptoms of your child, make an appointment with your doctor. Investigation may be recommended as the symptoms are not specific with the cancer.
Causes
The disease usually happens when nerve tissues develop immature cells that become abnormal and form into a tumor. Genetic mutation causes the abnormal cells to continue to grow out of control affect other normal cells. Causes of genetic mutation have not yet been determined by the specialists, but risk factors have been identified that increase the risk of having a neuroblastoma.
Risk factors
Factors that may increase neuroblastoma risk includes:
- Age: children age 5 years old and lower have higher risk to develop neuroblastoma.
- Family History: it is possible to develop the disease if there is a history of cancer within parents or siblings.
- Congenital defect: children born with birth defects have a higher risk to develop neuroblastoma compare normal birth.
Diagnosis
In order to diagnose neuroblastoma, the following procedures may be recommended:
- Physical examination: the specialist will perform a physical examination of the child to check for any signs and symptoms. Habits and behavior will also be discussed.
- Blood test: different kind of blood test will be ordered by the specialist.
- Urinalysis: the test will help check the levels of chemicals in the body.
- Diagnostic imaging procedure: includes computerized tomography (CT), magnetic resonance imaging (MRI), metaiodobenzylguanidine (MIBG) and Positron Emission Tomography (PET). This is to create a detailed imaging of the structure inside the body to accurately show abnormal masses in the body. It can show the size, shape, location and determine the extent of the cancer.
- Tissue biopsy – Tissue sample is being remove for testing. A small portion of a tissue sample will be removed, and sent to the pathology for testing for any signs of cancer.
- Bone marrow biopsy – A long, thin needle is inserted into the bone marrow (commonly at the pelvic bone) to aspirate fluid during the procedure, then the sample is sent to laboratory for pathology testing to determine the percentage of abnormal cells.
Staging
Once the specialist confirmed the diagnosis of neuroblastoma, then the following step is to know the extent (stage) of the cancer. The stages of cancer are indicated by Roman numerals ranging from 0 to IV. The lowest stage indicates a cancer is confined at one area. The highest stage – stage IV – indicates that the cancer had spread, and it is so called advanced stage.
Treatment
The treatment will be chosen based on the age, type, stage of the cancer, general health as well as personal choice treatment. Treatment options would be discussed with the specialist.
Surgery
The type of surgery will depend on the size and the location of the tumor. If the tumor is located near to vital organ such as the spinal cord or the lung, removing the entire tumor could damage healthy tissue and organ. Most children with low-risk neuroblastoma commonly receive surgery alone. When the tumor is small, it is possible to completely remove the tumor.
In children with intermediate risk or high-risk neuroblastoma, the surgeon will remove the tumor as much as it is not harmful.
Chemotherapy
Chemotherapy is a drug that uses chemicals to kill cancer cells. A combination or a single drug can be given. Chemotherapy can be given orally or intravenously. Children with intermediate-risk or high-risk neuroblastoma will receive chemotherapy prior surgery to reduce tumor size. Therefore, increase possibility of removing the entire tumor. Chemotherapy usually used before bone marrow transplant.
Radiation therapy
Radiation therapy is the use of high-energy beams to destroy or stop the growth of cancer cells. Radiotherapy may be used prior to bone marrow transplant. During the radiation, the beam will be directed to one specific area. Radiation therapy is usually used in children with high-risk neuroblastoma to prevent cancer from recurring after treatment. Children with low-risk or intermediate-risk neuroblastoma usually do not require radiation therapy but sometime cancer cells remain after chemotherapy and surgery. The Doctor may use radiation therapy to eliminate remaining cancer cells.
Bone marrow transplant
A bone marrow transplant is also known as stem cell transplant. The doctor may recommend this treatment option for children who have high-risk neuroblastoma. This procedure replaces your own healthy bone marrow cells (autologous transplant) into a patient after their own unhealthy bone marrow has been eliminated by high dose of chemotherapy.
Immunotherapy
Immunotherapy uses drugs to help the immune system to fight against cancer. Naturally, the immune system may not be able to harm cancer because cancer cells create proteins which the body’s immune system cannot detect. Immunotherapy interferes with this natural process. Immunotherapy may be used in children with high-risk neuroblastoma.
Iodine 131 Metaiodobenzylguanidine (I-131 MIBG)
Iodine-131 metaiodobenzylguanidine is a type of internal radiation therapy which will administered intravenously. I-131 MIBG will kill tumor cells with radiation directly. I-131 MIBG may use in children with high-risk neuroblastoma or patient with relapsed neuroblastoma.
