What causes neuroblastoma is often not known.
Symptoms depend on where neuroblastomas develop, such as the abdomen, chest, bone, skin, or spinal cord.
Diagnosis usually involves an imaging test and a biopsy.
Treatment depends on the child's age and the specific characteristics of the cancer and may include surgery, chemotherapy, and radiation.
(See also Overview of Childhood Cancer Overview of Childhood Cancer Cancer is rare among children. In 2021 in the United States, an estimated 10,500 children aged birth to 14 years will be diagnosed with cancer and slightly over 1,100 children will die of it... read more .)
A neuroblastoma develops in a certain kind of nerve tissue located in many places of the body. It usually originates in nerves in the abdomen or chest, most commonly in the adrenal glands Overview of the Adrenal Glands The body has two adrenal glands, one near the top of each kidney. They are endocrine glands, which secrete hormones into the bloodstream. Each adrenal gland has two parts. Medulla: The inner... read more (located above each kidney). Very rarely, a neuroblastoma originates in the brain. In over half of the children, the cancer has spread to other parts of the body by the time a doctor is consulted.
Neuroblastoma is the most common cancer among infants and one of the most common tumors among children of any age. About 90% of all neuroblastomas occur in children younger than 5 years. The cause of neuroblastoma is often not known. Most of these tumors occur spontaneously. Rarely, neuroblastomas run in families.
The symptoms of neuroblastoma depend on where the neuroblastoma originated and whether and where it has spread, as in the following:
Originating in the abdomen: The first symptoms include a large abdomen, a sensation of fullness, and abdominal pain.
Originating in the chest or neck: The child may cough or have difficulty breathing.
Spread to the bones: The child has bone pain. If the cancer reaches the bone marrow, the number of various types of blood cells may be reduced. A reduced number of red blood cells (anemia) causes a weak and tired feeling and sometimes pale skin (pallor). A reduced number of platelets causes easy bruising and tiny purple spots on the skin. A reduced number of white blood cells lowers the resistance to infection.
Spread to the skin: Lumps appear.
Spread to the spinal cord: The arms and legs may feel weak, or children may not be able to voluntarily control some body parts.
Less commonly, children have symptoms of a disorder called Horner syndrome Horner Syndrome Horner syndrome affects one side of the face, causing the eyelid to droop, the pupil to become small (constricted), and sweating to decrease. The cause is disruption of the nerve fibers that... read more . In Horner syndrome, a tumor in the neck presses on nerves that affect one side of the face. Children have a drooping eyelid, a small pupil, and decreased sweating on one side of the face.
About 90 to 95% of neuroblastomas produce hormones, such as epinephrine, which sometimes increase the heart rate and cause anxiety. Other syndromes associated with cancer (called paraneoplastic syndromes Paraneoplastic Syndromes Paraneoplastic (associated with cancer—see also Overview of Cancer) syndromes occur when a cancer causes unusual symptoms due to substances that circulate in the bloodstream. These substances... read more ), such as uncontrollable eye movements (opsoclonus) and quick contractions of the arms and legs (myoclonus), watery diarrhea, or high blood pressure, can occur.
Early diagnosis of a neuroblastoma is not easy. Occasionally, routine prenatal ultrasonography Ultrasonography Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more detects neuroblastoma in a fetus. If the cancer has grown large enough, a doctor may be able to feel a lump in a child's abdomen.
A doctor who suspects a neuroblastoma does CT Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more or MRI Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more of the abdomen. If a tumor is found, a sample is taken and sent to a laboratory for examination (biopsy). A bone marrow sample may be taken to look for cancer cells (see Bone Marrow Examination Bone Marrow Examination Red blood cells, most white blood cells, and platelets are produced in the bone marrow, the soft fatty tissue inside bone cavities. Sometimes a sample of bone marrow must be examined to determine... read more ).
A urine sample can be tested for excessive production of epinephrine-like hormones.
To see whether the cancer has spread, the doctor may do the following:
CT or MRI of the abdomen, pelvis, and chest and sometimes the brain
X-rays of bones
Examination of tissue samples from the liver, lungs, skin, bone marrow, or bone
A scan that uses a radioactive material known as metaiodobenzylguanidine (MIBG) that helps doctors see whether the neuroblastoma has spread
The doctor uses all of this information to determine whether the tumor is low risk, intermediate risk, or high risk.
Prognosis depends on several factors such as the child's age at diagnosis, whether the tumor has spread, and certain characteristics of the tumor called biologic features (for example, how the tumor looks under a microscope and some features of the DNA within the tumor cells). Younger children whose cancer has not spread have the best prognosis.
The survival rates for children who have low-risk and intermediate-risk disease are about 90%. The survival rate for children who have high-risk disease had been about 15%, but this rate has improved to greater than 50% with newer and intensified methods of combined therapy.
(See also Cancer Treatment Principles Cancer Treatment Principles Treating cancer is one of the most complex aspects of medical care. It involves a team that encompasses many types of doctors working together (for example, primary care doctors, gynecologists... read more .)
Treatment of neuroblastoma is based on the risk category.
Cancer that has not spread can often be removed and cured by surgery Surgery for Cancer Surgery is a traditional form of cancer treatment. It is the most effective in eliminating most types of cancer before it has spread to lymph nodes or distant sites (metastasized). Surgery may... read more .
Children who have intermediate-risk or high-risk disease are given chemotherapy drugs such as vincristine, cyclophosphamide, doxorubicin, etoposide, and cisplatin.
High-dose chemotherapy Chemotherapy Chemotherapy involves the use of drugs to destroy cancer cells. Although an ideal drug would destroy cancer cells without harming normal cells, most drugs are not that selective. Instead, drugs... read more with stem cell transplantation Stem Cell Transplantation Stem cell transplantation is the removal of stem cells (undifferentiated cells) from a healthy person and their injection into someone who has a serious blood disorder. (See also Overview of... read more is frequently used for children with high-risk disease. To reduce the risk of the cancer coming back after high-dose chemotherapy and stem cell transplantation, these children are given a drug called a retinoid, which is a chemical related to vitamin A.
Radiation therapy Radiation Therapy for Cancer Radiation is a form of intense energy generated by a radioactive substance, such as cobalt, or by specialized equipment, such as an atomic particle (linear) accelerator. Radiation preferentially... read more may be used for children with intermediate-risk disease or when tumors are inoperable and is standard treatment for tumors in children with high-risk disease.
Immunotherapy Immunotherapy for Cancer Immunotherapy is used to stimulate the body's immune system against cancer. These treatments target specific genetic characteristics of the tumor cells. The genetic characteristics of tumors... read more is the latest way to treat children who have high-risk disease. This therapy helps stimulate the body's immune system against cancer.
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Cancer Society: If Your Child Is Diagnosed With Cancer: A resource for parents and loved ones of a child who has cancer that provides information about how to cope with some of the problems and questions that come up just after a child is diagnosed