What is Neuroblastoma?

Neuroblastoma is a rare childhood cancer of what’s called the “sympathetic nervous system” -- the network of nerves that carries messages from your brain to the rest of your body.

The cancer most often begins around the adrenal glands, those hormone-producing organs that sit atop the kidneys and have cells similar to nerve cells. But neuroblastoma can also start in other areas of the body where groups of nerve cells are clustered.

Doctors most often diagnose it in children younger than age 5. It is rarely seen in children older than 10.

There are several types of treatments that help many children with neuroblastoma to survive and lead healthy lives. Parents also have resources they can turn to after getting the diagnosis.

What Causes It?

In general, cancers begin with changes (“mutations”) in some cells of a person’s body. The changes allow these cells to grow out of control. They can form tumors and often stop the cells from carrying out what they are normally supposed to do.

In neuroblastoma, the mutations affect immature nerve cells in a baby still in the womb. The cells are called neuroblasts. As the baby continues to grow before birth, the neuroblasts mature into functioning nerve cells.

In a healthy baby, the neuroblasts go away completely as the nervous system matures. But in babies with this condition, the mutated neuroblasts stick around and form a tumor.

Symptoms

They vary widely, depending on where a tumor is located, how big it is, and how far along in growth it is. Many of the symptoms might point to conditions other than neuroblastoma.

In a child’s abdomen, it may cause:

• Lumps or swelling in the belly
• Stomach pain or a constant feeling of being full, which can lead to weight loss
• Swelling in the child’s legs or in the scrotum caused by tumors pressing against blood and lymph vessels
• Problems peeing or having bowel movements

In the cheek or neck, it might cause:

• Swelling in the face, neck, arms, and chest
• Headaches and dizziness
• Coughing or trouble breathing or swallowing
• Changes to the eyes, including drooping eyelids and unequal pupil sizes

Neuroblastoma that has spread can cause symptoms including:

• Enlarged lymph nodes. They are felt as hard lumps in the armpits, neck, or groin. Although most often a sign of infection, they can be a result of cancer that has spread to the lymph system.
• Bone pain, weakness in the legs or arms, and bruising around the eyes may come from cancer that has gotten to the bones.
• If a neuroblastoma affects the bone marrow, which makes blood cells, a child may be tired, irritable, weak, and get a lot of bruises and infections.

Two other signs to watch for:

1. A special, widespread type of neuroblastoma that happens only during the first few months often causes blue or purple bumps that look like small blueberries. That’s a sign the cancer has possibly spread to the skin. This is very treatable and often shrinks or goes away on its own.

2. Neuroblastomas that release hormones may cause other symptoms, such as constant diarrhea, fever, high blood pressure, sweating, and reddening of the skin.

Diagnosis

Since many symptoms can be caused by more common conditions, your doctor will need to run lab tests, scans, and biopsies to be sure that your child has this rare cancer. These include:

• Blood and urine tests. These measure levels of hormones in your blood that may be made by neuroblastomas.
• Imaging tests. These can help doctors figure out how far a cancer has spread.
• Ultrasound. This can look for tumors in your abdomen.
• X- rays. These can find cancer in the chest and bones.
• Other types of scans. You might get CT, PET, or MRI scans so your doctor can figure out where else the neuroblastoma might be or whether a treatment is working.
• Biopsy. A doctor can take a sample from a tumor or bone marrow. A lab will run a test on the sample to detect cancer.

You might also get lab tests that measure your blood cell counts, liver and kidney function, and the balance of salts in your body.

Neuroblastoma is a cancer that can be treated. How much the cancer has spread is the most important factor in whether a child can be cured. The younger the age at diagnosis, the better the survival rate.

Treatment

The kind of treatment your child gets will depend on several things. They include:

• The “stage” of the cancer. (Doctors give cancers categories based on tumor sizes and whether they’ve spread.)
• The age of your child
• Where the tumor started
• How the tumor is expected to respond to treatment

The types of treatment your child might get include:

• Surgery. This takes out a tumor.
• Chemotherapy. Your child gets rounds of chemicals to kill cancer cells.
• Radiation therapy. This uses high-energy beams, such as X-rays, to kill cancer cells.
• Stem cell transplant. Your doctor collects your child’s own blood stem cells, uses chemotherapy to kill cancerous cells, then injects the healthy cells back into their body.
• Newer therapies. These include immunotherapies, which work by signaling your child’s immune system to help fight cancer cells.

Can I Lower My Child’s Chance of Getting It?

In a small percentage of neuroblastoma cases, children have inherited a genetic problem from their parents that gave them a higher chance for it.

However, there are no other things that are known to cause neuroblastoma.

Unlike many adult cancers, issues such as body weight, diet, exercise, and exposure to toxins and chemicals aren’t thought to be linked with the disease.

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