Neuroblastoma is a tumor of nerve tissue from the sympathetic nervous system that develops in infants and children. Neuroblastoma most commonly appears in the abdomen in the adrenal gland, but can also occur in the chest, neck, pelvis and other areas. Neuroblastoma can spread to the lymph nodes, liver, bones and bone marrow.
Is Neuroblastoma Common in Children?
Most commonly diagnosed before age 5 years, neuroblastoma is the most common solid tumor outside of the brain in children. The average age of a child diagnosed with neuroblastoma is about 18 months old. In the United States, about 800 new cases of neuroblastoma are diagnosed each year.
What Causes a Child to Get Neuroblastoma?
Many things can cause cells to stop maturing and grow out of control, but we have never found any one thing that causes neuroblastoma. Scientists have tested many ideas about the possible causes, but none of them have been found to cause neuroblastoma.
About 1% of children with neuroblastoma have an inherited risk of neuroblastoma, but usually there is not a clear reason why, or any way to protect a child from getting neuroblastoma.
What Are Some Common Signs and Symptoms of Neuroblastoma?
Symptoms of neuroblastoma vary depending on where the main tumor is in the body or how much the tumor has spread (metastasized).
A lump or mass in the belly (abdomen) or on the back next to the spine
A distended or swollen belly
Fevers for more than a week with no known cause
Bruising, especially around the eyes (“raccoon eyes”)
Decreased appetite
Constipation
Refusing to walk
Rapid eye movements (“dancing eyes” or “opsoclonus”)
New inability to walk normally or stand, especially after they were walking normally before
No symptoms (neuroblastoma can be found on scans done for other reasons)
How Is Neuroblastoma Treated?
Treatment depends on what the neuroblastoma tumor cells look like under the microscope, the aggressiveness of the neuroblastoma cells (based on special tumor genetic testing), and if the tumor is in one place or spread to many places in the body. All these pieces of information tell us if the disease risk is low, intermediate or high.
Low-risk neuroblastoma may only need monitoring or sometimes surgery to remove the tumor. Neuroblastoma in babies under 1 year of age often does not require any treatment other than close monitoring in the oncology clinic as the tumor can go away on its own (spontaneous regression).
Intermediate-risk neuroblastoma is usually treated with chemotherapy and/or surgery. Children with low and intermediate-risk neuroblastoma have excellent survival rates with few to minimal long-term complications from their tumor or their treatments.
High-risk neuroblastoma, mostly seen in children over 18 months of age with aggressive and metastatic disease, requires multiple courses of chemotherapy, surgery, high-dose chemotherapy, radiation therapy, and antibody therapy. Survival for children with high-risk neuroblastoma continues to improve with these intense treatments. High-risk neuroblastoma that doesn’t respond to therapy (refractory) or comes back (relapse) after therapy remains very challenging to treat.
Children with neuroblastoma and other childhood cancers are treated at Nationwide Children’s Hospital and many other pediatric hospitals across the USA and around the world. We work together to learn which treatments are best for children with cancer through organizations like the Children’s Oncology Group, so we can provide the best care for our children right here in Columbus, Ohio.
Who Should I Call If I’m Worried That My Child Might Have Neuroblastoma?
Your child’s pediatrician or primary care provider is the best place to start – they can perform a physical exam and order tests if needed.
Keri A. Streby, MD, is the Director of the Neuroblastoma Program at Nationwide Children’s Hospital and an assistant professor at The Ohio State University College of Medicine. She serves on the national Children’s Oncology Group Neuroblastoma Committee and her research interests include developing clinical trials for children with neuroblastoma, utilizing Curie scores as a prognostic marker for neuroblastoma, and neuroblastoma that recurs in the central nervous system. Clinically, she sees primarily oncology patients with a focus on neuroblastoma, MIBG therapy, and other embryonal tumors.
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