Neuroblastoma is a cancerous tumor. It grows in nerve tissue of babies and young children. The cancer cells grow in young nerve cells of a baby growing in the womb. These cells are called neuroblasts. It’s is the most common cancer in babies under age 1. It’s rare in children older than age 10.
In most cases, neuroblastoma starts in the adrenal glands or the nerve fibers in the abdomen. Other common places for it to grow include the nerve fibers near the spine in the chest, neck, or lower belly (pelvis).
The symptoms vary depending on the size and location of the tumor and if it has spread. Symptoms can also occur a bit differently in each child.
Symptoms of a tumor in the belly (abdomen) can include:
Symptoms of a tumor in the chest can include:
Symptoms of a neuroblastoma that has spread to other parts of the body can include:
A neuroblastoma may release hormones. This is called paraneoplastic syndrome. It can cause symptoms such as:
A neuroblastoma can also cause opsoclonus-myoclonus-ataxia syndrome. This can lead to symptoms such as:
The symptoms of neuroblastoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.
You may take your child to the healthcare provider because of a lump, swelling, or other symptoms. Most of the time, neuroblastoma has spread by the time it is diagnosed. Your child's healthcare provider will ask about your child's medical history and symptoms. He or she will examine your child. Your child may be referred to a specialist in diagnosing and treating cancer in children (pediatric oncologist).Your child may have tests such as:
Once neuroblastoma has been diagnosed, a stage is assigned. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. Doctors use two different staging systems for neuroblastoma: the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Risk Group Staging System (INRGSS).
The INSS system divides tumors into stages 1 through 4. It’s assigned after surgery has been done to remove the tumor. Stage 1 is early cancer. It's only in the place where it started and only on one side of the body. For neuroblastoma, this means the tumor can be fully seen and removed by surgery. Stages 2 and 3 are more complex. The tumor is harder to remove and cancer cells may have spread. Stage 4 means cancer cells from the tumor have spread to other parts of the body far from the primary tumor.
The INRGSS system divides tumors into 4 stages labeled L1, L2. M, and MS. Surgery does not need to be done before assigning one of these stages. They are based on how the tumor looks based on scans called image-defined risk factors (IDRFs) and biopsies. They are used to predict how much of the tumor can be taken put with surgery. The L groups means the cancer is confined to one part of the body. The M group means it has spread beyond where it first started to distant organs. MS is used in children younger than 18 months with cancer that has spread only to the skin, liver, or less than 10% of the bone marrow, or all three.
Grading is used to describe how abnormal the cancer cells look when seen through a microscope. The more abnormal the cells are, the faster they grow. Staging and grading help the healthcare team plan treatment for your child.
The healthcare team also looks at:
Your child’s healthcare team will tell you more about the stage and grade of your child’s cancer. The stages of neuroblastoma are very complex. Be sure to ask the healthcare provider to explain the stage of your child's cancer to you in a way you can understand. Also be sure to ask the healthcare provider if you have any questions.
Treatment will depend on the stage and other factors. The cancer can be treated with any of the below:
With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:
A child may have complications from the tumor or from treatment, such as:
A child with a neuroblastoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists.
You can help your child manage his or her treatment in many ways. For example:
Call the healthcare provider if your child has:
Tips to help you get the most from a visit to your child’s healthcare provider: