Neuroblastoma is a common childhood cancer that grows in parts of the nervous system.

• What causes neuroblastoma is not known.
• Symptoms depend on where neuroblastomas develop, such as the abdomen, chest, bone, skin, or spinal cord.
• Diagnosis usually involves an imaging test.
• Treatment involves surgery for tumors that have not spread, chemotherapy, and sometimes radiation therapy.

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 (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 is not known. Rarely, neuroblastomas run in families.

Symptoms

The symptoms 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: 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. 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.

About 90 to 95% of neuroblastomas produce hormones, such as epinephrine, which sometimes increase the heart rate and cause anxiety.

Diagnosis

Early diagnosis of a neuroblastoma is not easy. If the cancer has grown large enough, a doctor may be able to feel a lump in the abdomen. A doctor who suspects a neuroblastoma may suggest ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) of the chest and abdomen. A urine sample can be tested for excessive production of epinephrine-like hormones.

To see whether the cancer has spread, the doctor may do a bone scan, take x-rays of bones, or examine tissue samples from the liver, lungs, skin, bone marrow, or bone.

Prognosis and Treatment

Children younger than 1 year and children with small cancers have a very good prognosis. In children older than 1 year, the cure rate is low if the cancer has spread.

If the cancer has not spread, it can usually be removed by surgery. Most children are given chemotherapy drugs such as vincristine, cyclophosphamideSome Trade Names
LYOPHILIZED CYTOXAN
, doxorubicinSome Trade Names
DOXIL
, etoposideSome Trade Names
VEPESID
, and cisplatinSome Trade Names
PLATINOL
. Also, radiation therapy may be used in addition to surgery when chemotherapy is ineffective or when tumors are inoperable.

Last full review/revision January 2009 by David N. Korones, MD