Neuroblastoma is a type of cancer that develops in certain types of nerve cells but often appears first in the nerve-like cells of the adrenal glands, which sit right on top of the kidneys. It can also affect the nerves that surround our spine or nerves in the chest or abdomen. This cancer usually occurs in children, typically those younger than 5 years old.
Although childhood cancer in general is rare, neuroblastoma is one of the most common solid tumors in childhood. Sometimes neuroblastoma is found during a prenatal ultrasound. Prenatal neuroblastoma usually goes away without treatment. Neuroblastoma in older children requires medical treatment. It does not go away on its own.
Symptoms depend on where the mass is located and can vary from child to child. The most common symptoms of neuroblastoma are:
- A lump in the abdomen
- Bulging eyes
- Dark circles around the eyes
- Bone pain
- Weakness or paralysis
- High blood pressure
- Watery diarrhea
- Feeling tired
- Easy bruising or bleeding
- Swelling in the stomach that can cause difficulty breathing, especially in infants and younger children
- Uncontrolled eye movements or “dancing eyes” (less common)
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.
Diagnosis of Neuroblastoma
A biopsy of tumor tissue is the only way to diagnose neuroblastoma. The tissue sample is then sent for additional testing to find out exactly what kind of cells make up the tumor and if there are certain genetic factors in the cell to help determine prognosis.
In addition to a biopsy, tests may include:
- Ultrasound. This imaging test can help determine the tumor’s size. Ultrasound uses high-frequency sound waves to create pictures of the inside of the body.
- Computed tomography (CT). This fast, painless imaging procedure creates multiple detailed or three-dimensional images. It can also help determine the size of a tumor.
- Metaiodobenzylguanidine (MIBG) scan. This imaging test can reveal neuroblastoma cancer cells anywhere in the body. A radioactive dye is injected into the bloodstream through a vein. When cancer cells absorb this dye, a scanner can detect them.
- Bone marrow aspiration. This test collects bone marrow, which is sent to a pathologist to look for any signs of cancer. Your child will be under anesthesia during the test. A large needle is placed into the hipbone to remove bone marrow.
Treatment depends on the stage of the cancer. Prenatally diagnosed neuroblastoma may only need monitoring with doctor visits and ultrasounds until it goes away on its own.
Other patients may only need surgery to remove the tumor. Patients with higher stage neuroblastoma need surgery and chemotherapy. Chemotherapy kills any remaining cancer cells left behind after the surgery.
Stage IV is the highest stage of neuroblastoma and the most difficult to treat. Children with stage IV neuroblastoma may receive a combination of therapies such as:
- Chemotherapy to kill cancer cells
- Surgery to remove the tumor
- Radiation therapy to shrink the tumor before surgery or to destroy any remaining cancer cells after surgery and chemotherapy
- Stem cell transplant to replace a patient's bone marrow cells with healthy cells after high-dose chemotherapy/radiation therapy
- Antibody therapy (immunotherapy), a medicine that uses a patient’s own immune system to fight cancer
Key Points to Remember
Key Points to Remember
- Neuroblastoma is a solid cancerous tumor usually found first in the adrenal glands, which sit on top of the kidney.
- Symptoms of neuroblastoma depend on where the mass is located and can vary from child to child.
- A biopsy of tumor tissue is the only way to diagnose neuroblastoma.
- Treatment for neuroblastoma depends on the stage of the cancer and may include surgery, chemotherapy, radiation therapy, stem cell transplant and antibody therapy.
Support Services & Resources
Support Services & Resources
Visit these websites to learn more about neuroblastoma, its symptoms and treatments.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
Riley at IU Health is a member of the Children's Oncology Group Phase 1 & Pilot Consortium, an organization that is dedicated to pediatric cancer research. Ask your child's doctor for more information about our current research on neuroblastoma and available clinical trials.
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