Neuroblastoma

Neuroblastoma is a type of pediatric cancer that develops in the nervous system of babies and young children. Neuroblastoma grows in immature nerve tissue (neuroblasts).

Causes of Neuroblastoma #

• Neuroblastoma happens when immature nerve tissues (neuroblasts) grow out of control.

• The cells become abnormal and continue growing and dividing, forming a tumor.

• A genetic mutation (a change in the neuroblast’s genes) causes the cells to grow and divide uncontrollably.

• Healthcare providers aren’t sure what causes the genetic mutation.

• Children with a family history of neuroblastoma are more likely to develop this type of cancer.

• But about 98% to 99% of the time, neuroblastoma is not inherited (or, passed down in families).

• Children born with other congenital anomalies (birth defects) may have a higher risk of developing neuroblastoma.

Symptoms of Neuroblastoma #

• Bump or lump in the neck, chest, pelvis or abdomen (belly), or several lumps just under the skin that may appear blue or purple (in infants).

• Bulging eyes or dark circles under eyes (it may look like the child has a black eye).

• Diarrhea, constipation, upset stomach or loss of appetite.

• Fatigue, cough and fever.

• Pale skin, which is a sign of anemia (low red blood cells).

• Painful, bloated belly.

• Trouble breathing (usually in young babies).

• Weakness, movement problems or paralysis in the legs and feet.

Diagnosis of Neuroblastoma #

Blood and urine tests #

• To check for anemia and abnormalities in the blood, your child’s provider will order a complete blood count (CBC).

• Blood chemistry tests measure hormone levels and detect substances in the blood that may be a sign of cancer.

• A urine test measures the levels of chemicals in your child’s body.

Biopsy #

• During a biopsy, your child’s provider removes a tissue sample and sends it to a laboratory.

• The laboratory will look at the tumor tissue under a microscope, and perform various tests on the biopsy sample to confirm the diagnosis of neuroblastoma.

• Specialized tests of the biopsy sample will check for specific chromosomal alterations of the tumor cells themselves this can help determine your child’s risk category and treatment plan.

Bone marrow biopsy #

A bone marrow biopsy tests bone, bone marrow and blood for signs of cancer. Bone marrow is the sponge-like tissue at the center of large bones. Blood cells form in bone marrow.

CT scan #

During a CT scan, your provider injects a special dye into your child’s vein and then performs a series of X-rays. The dye makes it easier for the provider to see tissues and tumors.

MRI scan #

An MRI scan uses a magnet and radio waves to produce images of soft tissues.

Methyliodobenzylguanine (MIBG) scan #

This imaging test uses a safe radioactive chemical called 123-iodinated MIBG radiotracer. Your child’s provider injects radiotracer into a vein, and the next day, uses a special type of scanner to take pictures of your child’s organs.

Ultrasound #

An ultrasound test uses high-frequency sound waves to create images of soft tissues.

X-ray #

A chest X-ray or abdominal X-ray can help your child’s provider see the location of the tumor and how it’s affecting other tissues in the body. An X-ray is an easy screening test to determine a less detailed picture of how the cancer is affecting the body.

Treatment of Neuroblastoma #

Chemotherapy #

• Chemo stops cancer cells from multiplying.

• Healthcare providers inject chemotherapy drugs through a vein.

• It usually requires treatments over several weeks or months.

• The type of chemotherapy regimen and length of treatment depends on which risk category of neuroblastoma your child has.

Surgery #

Surgeons remove the tumor through an incision, but it may not be possible to remove the entire tumor. Some children receive chemotherapy before or after surgery to shrink a tumor or destroy remaining cancer cells.

Radiation #

• This treatment kills cancer cells or stops them from multiplying.

• Radiation therapy uses high levels of radiation to target cancer cells.

• Radiation oncologists often use radiation to prevent cancer from coming back after treatment.

• Radiation is most often used in high-risk neuroblastoma patients. Low and intermediate-risk patients usually do not require radiation therapy.

Immunotherapy #

• Sometimes, cancer cells remain after chemotherapy and radiation. Providers may use immunotherapy to train the body to attack abnormal cells.

• Your child’s provider injects antibodies (cells that fight infection) through a vein.

• The currently used immunotherapy medications target a protein called GD2, which sits on the outside of the neuroblastoma cell.

• The antibodies find GD2 proteins on neuroblastoma cells and attach to them, which signals the body’s immune system to destroy them.

Iodine 131-MIBG therapy #

• This treatment uses radiation to target tumor cells. Your child’s provider injects radioactive iodine into the bloodstream through a vein.

• The radioactive iodine kills tumor cells with radiation.

• This treatment has been used in children whose neuroblastoma has come back or when it won’t go away (relapsed or refractory disease), and is being studied when given as part of frontline therapy in high-risk neuroblastoma.