Neuroblastoma: Comprehensive Cancer Information

Neuroblastoma

Neuroblastoma is a type of cancer that develops from immature nerve cells, or neurons, of the sympathetic nervous system. This system is part of the autonomic nervous system, which plays a vital role in controlling essential body functions such as breathing, blood pressure, and digestion.

General Information

Incidence: Neuroblastoma is the most common cancer diagnosed in infants and the fourth most common cancer overall in children. It accounts for approximately 7% of all paediatric cancers.
Age of Onset: It almost always develops before a child reaches five years of age, with the average age of diagnosis being between one and two years. It can occasionally be detected on an ultrasound scan before a baby is born.
Formation: Most neuroblastomas start in the adrenal glands, the abdomen, or in nerve cell clusters (called ganglia) located next to the spinal cord. They can also occur in the neck, chest, or spine.
Growth Pattern: Some tumours grow quickly, while others are slow-growing. Neuroblastoma diagnosed in infancy often tends to be less aggressive and may even regress and become benign. However, in children older than 18 months, the cancer is typically more aggressive.
Terminology: If the neuroblastoma continues to grow during treatment, it is termed progressive neuroblastoma. If the cancer returns after a period of remission, it is called recurrent neuroblastoma.

Neuroblastoma Symptoms

Neuroblastoma can sometimes present with no obvious symptoms, and its signs can often be mistaken for those of other, more common conditions. The symptoms a child experiences depend on the tumour's location, size, whether the cancer has spread, and if it is producing hormones.

Possible symptoms may include:

Bruising

Diarrhoea

Loss of Appetite & Weight Loss

Fatigue

Lumps

In the abdomen, lower back, neck, or chest

Bone Pain

If the cancer has spread to the bone

Eye Changes

Bulging eyes, drooping eyelid, or dark circles under or around the eyes

Swollen Stomach

A swollen, distended stomach

Breathing Issues

Breathing difficulties or coughing

Difficulty Swallowing

Weakness or Paralysis

In the lower limbs

Systemic Symptoms

Fever, anaemia, and high blood pressure

Swelling

Of the legs or scrotum

Urinary/Bowel Issues

Problems with urination or bowel movements

Headaches & Dizziness

Important: It is important to remember that most children with these symptoms do not have neuroblastoma; they are typically caused by less serious issues. However, it is always advisable to consult a paediatrician to address any health concerns.

Neuroblastoma Diagnosis

Neuroblastoma can be challenging to diagnose. The highly specialised experts at SSCHRC possess extensive experience and employ the most advanced technology to accurately pinpoint the disease. This commitment helps ensure the delivery of the most effective treatments with minimal impact on your child's developing body.

As neuroblastoma often has few early symptoms, it may metastasise (spread) to other parts of the body before it is discovered. In rare early stages, it might be found during routine medical examinations.

Neuroblastoma Diagnostic Tests

If your child's doctor suspects neuroblastoma, the initial step involves a thorough physical examination, along with a detailed discussion about your child's health history.

One or more of the following diagnostic tests may be used to confirm a diagnosis, determine if the cancer has spread, and monitor the effectiveness of treatment:

1. Imaging Tests

Several imaging methods can be used to visualise the tumour and check for spread:

CT (computed tomography) scans
MRI (magnetic resonance imaging) scans
MIBG scan (A chemical called MIBG, combined with radioactive iodine, is injected into a vein; images are then taken with a special camera as it travels to the tumour cells)
X-rays
Bone scans
Ultrasound
PET (positron emission tomography) scans

2. Biopsy

If an imaging test detects a tumour, a biopsy is performed to confirm if it is neuroblastoma. This involves a doctor removing a small sample of cells for examination under a microscope. A biopsy is typically performed in one of two ways:

Surgery: An incision is made near the tumour, and cells are removed.
Needle Biopsy: A thin, hollow needle is inserted into the tumour, and suction is used to remove tissue. A CT scan may be used to guide the needle if the tumour is difficult to access.

3. Other Tests

Bone marrow aspiration and biopsy
Blood and urine tests

Neuroblastoma Treatment

Treatment for neuroblastoma is often complex and requires a multi-speciality approach. SSCHRC offers a comprehensive team approach, bringing together leading oncologists, surgeons, radiologists, and radiation oncologists, along with highly specialised support staff, to personalise your child's treatment plan. Their goal is to deliver therapies that offer the highest chance of success while minimising the impact on the child's growing body.

Key factors influencing treatment options are:

Your child's age and overall health
The size, location, and characteristics of the tumour
Whether the cancer has spread to other parts of the body

While some low-risk neuroblastoma tumours may resolve without treatment, and others can be cured by surgery alone, aggressive treatment combinations are often required if the cancer has spread.

Treatment modalities include:

Surgery

Surgical intervention is commonly used to remove as much of the tumour as possible. Nearby lymph nodes may also be removed to check for cancer spread.
In some cases, the entire tumour can be removed. If the tumour is near vital organs or large blood vessels, only partial removal may be possible, followed by chemotherapy and radiation therapy.
Chemotherapy is sometimes administered before surgery to shrink the tumour, making it easier and safer to remove (neoadjuvant chemotherapy).

Chemotherapy

Neuroblastoma frequently spreads to other parts of the body, such as the lymph nodes, bone marrow, liver, bones, or lungs, before diagnosis. Since chemotherapy travels throughout the body, it is a highly effective systemic treatment.
SSCHRC provides the most advanced chemotherapy options, which may be given before surgery (neoadjuvant), after surgery (adjuvant), or as the main treatment if the tumour cannot be removed surgically.

Radiation Therapy (Radiotherapy)

This treatment uses high-energy beams to destroy cancer cells. Modern techniques allow SSCHRC doctors to target tumours more precisely, delivering the maximum radiation dose while sparing healthy cells.
Radiotherapy may be used after surgery, after a stem-cell transplant, or to alleviate symptoms such as pain and breathing difficulties.

MIBG Radiotherapy

Children with advanced neuroblastoma may benefit from this specialised form of treatment. A radioactive chemical is injected into the bloodstream, travelling directly to the neuroblastoma tumour cells throughout the body.

High-Dose Chemotherapy/Radiation Therapy and Stem Cell Transplant

A stem cell transplant may be beneficial for children with treatment-resistant or advanced neuroblastoma.

Retinoid Therapy

Treatment involving Vitamin A or a Vitamin A-like compound may be prescribed for some patients.

Targeted Therapies

SSCHRC is at the forefront of neuroblastoma treatment, developing innovative targeted therapies. These agents are specifically designed to attack the unique genetic and molecular profile of each cancer to help a child's body fight the disease. Many doctors who treat neuroblastoma at SSCHRC are dedicated researchers who actively lead national and international clinical trials for these novel agents.