14390 Neuroblastoma

Overview

Neuroblastoma is a type of cancer that starts in immature nerve cells. These cells are part of the body's sympathetic nervous system, which helps control things like heart rate and digestion. The cancer most often begins in the adrenal glands, which sit on top of the kidneys, but it can also start in the chest, neck, abdomen, or spine.

Neuroblastoma is rare overall. Each year, it affects about 1 in 100,000 children. It is the most common cancer in infants under 1 year of age.

It mainly affects infants and children under 5, with a peak around age 1 to 2. It is slightly more common in boys. It can rarely occur in older children and adults.

Symptoms

Common symptoms

• Swelling or a lump in the belly (abdomen) that is painless
• Bone pain or limping
• Unexplained fever
• Tiredness or weakness
• Dark circles under the eyes
• Fussiness or poor feeding in a baby
• Trouble breathing or coughing (if tumor is in chest)
• Bowel or bladder changes (if tumor is in pelvis)

Symptoms in children

• Limping or refusing to walk
• Eye changes like bruising or a bulging eye
• Blue or purple lumps on the skin that look like blueberries
• High blood pressure
• Paralysis or weakness in legs (if spinal cord is compressed)

Causes

Main causes

• The exact cause is unknown. It starts when a nerve cell's DNA changes (mutation), causing it to grow out of control.
• This is not inherited in most cases.
• Some rare genetic conditions can increase risk.

Risk factors

• Family history of neuroblastoma (very rare)
• Certain genetic conditions such as ALK gene mutations or Li-Fraumeni syndrome
• Being born with certain inherited conditions like Hirschsprung disease or congenital central hypoventilation syndrome
• Most cases have no identifiable risk factor.

When to see a doctor

See a doctor urgently if:

• If your child has any of the emergency symptoms above, call emergency services immediately.
• If you notice a new lump, persistent bone pain, unexplained fever, or changes in your child's eyes, seek urgent medical care.

Book a routine appointment if:

• If your child is not growing or gaining weight as expected, has ongoing tiredness, or you have any general concerns about their health, book an appointment with your GP.

Diagnosis

A doctor will start by asking about symptoms and doing a physical exam. They may feel the belly for a lump. If neuroblastoma is suspected, tests are arranged through a specialist hospital team.

Tests that may be done

• Urine test to check for certain chemicals (catecholamines) that nerve cells release
• Blood tests
• Imaging scans such as ultrasound, CT, MRI, or MIBG scan (a special nuclear medicine scan that highlights neuroblastoma cells)
• Biopsy – a small piece of tumor is removed and examined under a microscope
• Bone marrow aspiration and biopsy to see if cancer has spread to the bone marrow

What to expect at your appointment

These tests are usually done by a specialist pediatric oncology team in a children's hospital. You will be carefully guided through each step. Children may need sedation or anesthesia for some scans and procedures. It can be a stressful time, but the team will explain everything and help you and your child.

Treatment

Treatment depends on the child's age, the tumor's genetic features, and whether it has spread (stage). Each child's treatment is personalized by a team of specialists. The main types of treatment are surgery, chemotherapy, radiation therapy, immunotherapy (using the body's immune system to fight cancer), and stem cell transplant.

Self-care at home

• Follow the cancer team's advice on wound care and managing side effects
• Keep a diary of symptoms and report any changes
• Maintain a routine as much as possible
• Ask for help from family, friends, or support services
• Give your child time to rest, but encourage normal play when they feel well

Medical treatments

Medical treatments are given by specialists and may include chemotherapy (medicines that kill cancer cells), radiation therapy (high-energy rays to shrink tumors), immunotherapy (medicines that help the immune system attack cancer cells), and high-dose chemotherapy with stem cell rescue (transplant). The exact combination depends on the child's risk group. Your child's team will explain the plan and possible side effects in detail.

When is surgery considered?

Surgery may be used to remove the tumor if it has not spread widely. In some cases, surgery is done after chemotherapy to shrink the tumor first. If the tumor is pressing on the spinal cord, emergency surgery may be needed.

Living with this condition

Living with neuroblastoma involves regular hospital visits, tests, and treatments. Many children respond well, but the journey can be long. It helps to focus on small daily goals, keep a normal routine where possible, and stay open with your child's care team.

Lifestyle tips

• Keep handwashing and hygiene routines to reduce infection risk
• Maintain a healthy sleep schedule
• Stay active with gentle play or walks as energy allows
• Limit contact with people who are sick, especially during chemotherapy

Diet and exercise

A healthy, balanced diet supports overall strength. If your child has side effects like nausea or sore mouth, the dietitian can suggest soft, easy-to-eat foods. Gentle exercise like walking or playing can help mood and energy, but rest when tired.

Mental health and emotional wellbeing

A cancer diagnosis affects the whole family. Feelings of fear, sadness, anger, and worry are normal. Parents and siblings may also need support. Speak with your care team about psychological help, counseling, or kid-friendly therapy.

Prevention

Most neuroblastomas happen by chance. There is no known way to prevent it. Parents can't do anything to cause or prevent it. Focus on early recognition and prompt check-up of any unusual symptoms.

Vaccines

There is no vaccine to prevent neuroblastoma.

Screening programmes

There is no routine screening test for neuroblastoma in the general population. Research looked at screening babies, but it did not reduce severe cases, so it is not done.

Complications

If left untreated

• Untreated neuroblastoma may continue to grow and spread to bones, bone marrow, liver, and other areas.
• It can press on the spinal cord and cause paralysis, block the bowel or bladder, or cause serious breathing problems.
• This can be life-threatening.

Long-term outlook

The outlook for neuroblastoma is better for children under 18 months and for lower-risk tumors. Many children are cured, especially those with early-stage or favorable biology. Even with high-risk disease, newer treatments are improving survival. Your child's medical team will give you a clearer idea based on their exact situation.

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