Neuroblastoma (patient information)

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 * Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Neuroblastoma is a rare type of cancer occurs in infants and young children. It is a cancer origins from nerve tissue. It may be found in the adrenal glands, in the neck, chest or spinal cord. The cancer often begins in early childhood. Sometimes it begins before a child is born. By the time doctors find the tumor, it has usually spread to other organs. Usual symptoms are a lump in the abdomen, neck or chest, bulging eyes, dark circles around the eyes, bone pain, swollen stomach and trouble breathing in babies, painless, bluish lumps under the skin in babies and inability to move a body part. Treatments include surgery, radiation therapy, chemotherapy, or a combination.

What are the symptoms of Neuroblastoma?
The signs and symptoms of neuroblastoma can vary widely depending on where the disease first started and how much it has spread to other parts of the body. Usual symptoms include:


 * Irritability, fatigue, loss of appetite, and fever in infant.
 * A swollen stomach, abdominal pain, and decreased appetite in young child.
 * Bone pain or soreness, black eyes, bruises, and pale skin
 * Weakness, numbness, inability to move a body part, or difficulty walking
 * Horner's syndrome: Drooping eyelid, unequal pupils, sweating, and red skin
 * Difficulty breathing

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at highest risk?
Scientists found the cause of neuroblastoma is related to abnormalities in the DNA of neuroblasts.

When to seek urgent medical care?
Call your health care provider if symptoms of neuroblastoma develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
 * Abdominal pain in child
 * Bone pain in child

Diagnosis

 * Blood or urine catecholamine tests: Neuroblastoma can often be found by detecting metabolites of catecholamines in the blood or urine: homovanillic acid (HVA) and vanillylmandelic acid (VMA).
 * Biopsy: During a biopsy, the doctor removes a sample of the tumor mass. This is the most important test for cancer.
 * Meta-iodobenzylguanidine (MIBG): This test is preferred by many doctors as a standard way to evaluate children with neuroblastoma. The goal of the test is to find the neuroblastoma and spot whether it has spread to the bones and/or other parts of the body.
 * Computed tomography (CT): CT scan can confirm the location of the cancer and show the organs nearby. This allows doctors to find the neuroblastoma and spot whether it has spread to the bones and/or other parts of the body. CT scans can be useful to look for neuroblastoma in the abdomen, pelvis, and chest.
 * X-rays: X-rays can be useful for looking for cancer spread to the bones and lungs.
 * Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.
 * Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy which in turn is used to produce the images. PET can provide more helpful information than either CT or MRI scans. It is useful to see if the cancer has spread to the lymph nodes and it is also useful for your doctor to locate where the cancer has spread.

Treatment options
Patients with neuroblastoma have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, retinoid therapy, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.


 * Surgery: For smaller tumors that have not spread, surgery is often the only treatment.
 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.
 * Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Common drugs include cyclophosphamide or ifosfamide, cisplatin or carboplatin.
 * High-dose chemotherapy/radiation therapy and stem cell transplant: This type of treatment is sometimes used in children with high-risk neuroblastoma who are unlikely to be cured with other treatments.
 * Retinoid therapy: This kind of treatment is thought to help some cells to differentiate into normal cells. For children with high-risk neuroblastoma, 13-cis-retinoic acid is used to reduce the risk of recurrence after high-dose chemotherapy and stem cell transplant.

Diseases with similar symptoms

 * Nephroblastoma
 * Teratoma
 * Rheumatic fever
 * Acute leukemia
 * Osteomyelitis

Where to find medical care for Neuroblastoma?
Directions to Hospitals Treating Neuroblastoma

Prevention of Neuroblastoma
Because the risk factor is not clear, the preventive measure is unknown.

What to expect (Outlook/Prognosis)?
The prognosis of neuroblastoma is poor and it depends on the following:
 * Whether or not the tumor can be removed by surgery.
 * The stage of the cancer: the size of the tumor, whether the cancer has spread
 * The child’s general health

Possible complications

 * Spread (metastasis) of the tumor
 * Damage and loss of function of involved organ(s)
 * Kidney failure
 * Liver failure
 * Loss of blood cells produced by the bone marrow
 * Decreased resistance to infection
 * Other organ system failures