What is Neuroblastoma?

Neuroblastoma is a tumour arising from special (sympathetic) nerve cells which run in a chain like fashion up the back of a child's abdomen and chest and into the skull, following the line of the spinal cord. The most common site for a neuroblastoma to grow is in the abdomen. About 50% start in the adrenal gland lying above the kidney but some tumours grow at the back of the chest and occasionally even higher up towards the neck. Neuroblastomas can frequently spread to the bones, lymph glands and bone marrow. In infants it may spread to the liver and skin. 

Signs and symptoms

The site of the tumour may cause differing symptoms at the time of diagnosis. For example, a tumour right at the back of the abdomen, which has grown to press on the spinal cord, may, among other possible symptoms, cause the child to begin to walk unsteadily or to have difficulty passing urine. A child who has a tumour in the chest may have problems with chest infections, cough or fluid in the lung, and this may need treatment before the neuroblastoma itself is treated. The child may also have loss of appetite, vague aches and pains and sweating, or a lump may be felt or seen.

Diagnosis

A CT, MRI scan or ultrasound will be done to show the extent or limit of the primary tumour. Usually, it is necessary to take a biopsy of the tumour to confirm diagnosis. Once the diagnosis has been confirmed an MIBG scan is performed to reveal the extent of spread of the neuroblastoma and a bone marrow examination is done to assess whether there is spread there as well. 

Treatment

The extent or spread of the tumour, together with the biology of the tumour and the age of the child will determine what chemotherapy (if any) will be required. Surgery can be difficult and may not be able to be performed safely until the tumour has been shrunk by chemotherapy. Treatment may vary from observation alone, to intensive chemotherapy, surgery, radiotherapy and immunotherapy which may last for ~18 months. The outcomes for neuroblastoma in children are vary variable and depend significantly on the results of the above tests. For example, many infants are cured with minimal therapy, but older children with metastatic disease have a poor prognosis even with intensive therapy. 

Follow-up care

After treatment has finished the child will be seen at regular intervals. Clinical examinations, urine, blood and ultrasound scans to monitor progress will be carried out to detect any possible recurrence. After the first few years the focus of follow up changes to monitoring growth and development and other possible later side effects of treatment.