Pediatric neuroblastoma

What is a pediatric neuroblastoma?

Neuroblastoma tumors usually form in nerve tissue on the kidneys, abdomen, neck, chest, pelvis or spinal cord. These tumors tend to spread to other parts of the body, including bones and bone marrow.

Treatment is most effective when we detect the cancer early. Kids younger than 18 months often do very well, even when their cancer has spread.

What are the different types of a pediatric neuroblastoma?

Neuroblastoma includes several types of tumors. These types are defined by whether the tumor continues to grow or not.

• Ganglioneuroma - This type of neuroblastoma stops growing, which means it isn’t considered cancer anymore. It becomes an extra lump of tissue that we remove through surgery.

• Neuroblastoma - Traditional neuroblastoma continues to grow, which means it is cancerous. We have multiple ways of treating this type, including surgery, chemotherapy and radiation therapy.

• Ganglioneuroblastoma - This type is like a combination of the other two. Some of the tumor cells stop growing, while some continue. We treat these the same way we treat neuroblastomas.

What are the signs and symptoms of a pediatric neuroblastoma?

In most cases, doctors notice a lump or swelling in the child’s abdomen during a regular check-up. The tumor may also cause pain or interfere with other parts of the body.

Common symptoms include:

• A mass or lump in the abdomen

• Bone pain

• Resistance to walking

• Constipation

• Fever

How is a pediatric neuroblastoma diagnosed?

• DNA testing - First, we take a sample of the tumor to study its cells and DNA. This tells us what kind of tumor it is and helps us plan treatment. For example, some neuroblastomas have a genetic mutation that makes the cancer more dangerous. When we see that mutation in the DNA test, we know to treat it more aggressively.

• Imaging - We also do tests to see whether the cancer has spread. These include a CT scan, a bone marrow sample and an MIBG scan. The MIBG scan is a special test that helps us detect neuroblastoma cells that are otherwise hard to find.

• Risk level - We use factors like your child’s age, the type of tumor they have, the tumor’s location and whether it has spread to decide the level of risk your child’s cancer poses.

What causes a pediatric neuroblastoma?

No one is exactly sure what causes these tumors. They form while a baby is growing in the womb.

How is a pediatric neuroblastoma treated?

We base our treatment plan on what risk group your child falls in.

Risk groups

• Low risk - This often means the cancer is limited to a small mass in one place. We can usually treat it with surgery alone.

• Intermediate risk - In this case, the cancer has spread somewhat. We treat it with surgery and chemotherapy.

• High risk - This means the cancer has spread or has characteristics that make it especially dangerous. We use a combination of treatments for these cases.

  • We start with chemotherapy, followed by surgery.

  • After that, we can do a stem cell transplant to help your child’s body rebuild cells.

  • Then we use radiation therapy on the spots where cancer remains.

  • Lastly, we use a special drug that targets neuroblastoma cells in order to kill them.

MIBG therapy - If the cancer returns after treatment, we can use a new kind of radiation therapy called MIBG therapy for some children. We are also doing a study to see if this therapy is effective in the early stages of treatment.