Neuroblastoma

Signs and symptoms of neuroblastoma

Neuroblastoma is one of the most common childhood cancers. The tumors often start in the abdomen. They can spread to other areas of the body, like lymph nodes, the liver, bones and bone marrow. The symptoms of neuroblastoma are different for everyone. They depend on where the tumors are in the body and how much it has spread (metastasized).

While the most common starting site in the body is the abdomen, it can also start in the chest, neck and pelvis. We work with specialists for each area of the body to ensure the plan of care for your child is the best plan for them.

Common symptoms include:

• A lump in the abdomen (belly area)
• Bulging eyes
• Dark circles around the eyes
• Bone pain
• Easy bruising or bleeding
• Weakness or paralysis
• High blood pressure
• Diarrhea
• Trouble breathing (because of the lump in the abdomen)

Symptoms can appear early or late depending on the stage of the cancer and age of the child. In very small infants, swelling of the abdomen and difficulty breathing may happen early. In older, bigger children, it may take longer to notice a mass in the belly. Other symptoms such as bone pain and bruising may appear first.

Neuroblastoma affects each patient differently, depending on where it is and how much it has spread. Because neuroblastoma usually develops near the kidneys, many children will have high blood pressure. Additionally, these cancer cells can also cause diarrhea and facial flushing (redness). If neuroblastoma is in the bone marrow, children may have bone pain as well. If the tumor is too close to the spinal cord, the child may have difficulty using his or her arms or legs and may experience weakness or even paralysis.

Although the exact cause of the condition is unknown, neuroblastoma sometimes results from a gene mutation that can be inherited (passed from parent to child). Children with the gene mutation are usually diagnosed at a younger age than those without the gene mutation. However, there does not have to be a genetic mutation to develop neuroblastoma.

Diagnosing Neuroblastoma

Diagnosing neuroblastoma is a multi-step process. A biopsy, which is a tissue sample from the tumor, is the only way to diagnose neuroblastoma. A biopsy is generally done under anesthesia. Then we send the tissue sample for testing to find out exactly what kind of cells make up the tumor. This allows us to see if there are certain genetic factors that might be targets for new drugs.

In addition to a biopsy, there are several other types of tests that will help the solid tumor team decide on the right treatment plan for each patient. Those tests may include:

• 1231-MIBG scan. This type of scan uses a small amount of radioactive dye that is linked to a specific neuroblastoma chemical. It is injected into the bloodstream and the cancer cells absorb the dye. The scan is then done 24 hours later and will show where the cancer is located in the body.
• PET scan. This is another scan which uses radioactive dye and is used for the 10-15% of cases where the MIBG scans would not work. The dye process is the same as the MIBG scan.
• CT and MRI scans. These scans create multiple detailed or three-dimensional images. They can help doctors determine the size and spread of the tumor.
• Bone marrow aspiration or biopsy. This test collects bone marrow, which is sent to a pathologist to look for any signs of cancer. It is collected either by aspiration, where a large needle is placed into the hipbone or by biopsy, where a small piece of bone marrow is cut out. Your child will be under anesthesia during these tests.