Neuroblastoma (cont.)
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the
following:
Age of the child when diagnosed. Stage of the cancer. Where the tumor is in
the body. Tumor histology (the shape, function, and structure of the tumor
cells). Prognosis and treatment decisions for neuroblastoma are also affected by
tumor biology, which includes:
The patterns of the tumor cells. How different the tumor cells are from
normal cells. How fast the tumor cells are growing. The number of chromosomes in
the tumor cells. How many copies of the N-myc gene there are. The tumor biology
is said to be favorable or unfavorable, depending on these factors. A favorable
tumor biology means there is a better chance of recovery.
Stages of neuroblastoma
After neuroblastoma has been diagnosed, tests are done to find out if cancer
has spread from where it started to other parts of the body.
The process used to find out the extent or spread of cancer is called
staging. The information gathered from the staging process helps determine the
stage of the disease. For neuroblastoma, stage is one of the factors used to
plan treatment. The following tests and procedures may be used to determine the
stage:
- Bone marrow aspiration and biopsy: The removal of a small piece of bone, bone
marrow, and blood by inserting a needle into the hipbone or breastbone. A
pathologist views both the bone and bone marrow samples under a microscope to
look for signs of cancer.
- Lymph node biopsy: The removal of all or part of a
lymph node. A pathologist views the tissue under a microscope to look for cancer
cells. One of the following types of biopsies may be done:
- Excisional biopsy: The removal of an entire lymph node.
- Incisional biopsy or core biopsy: The removal of part of a lymph node using a wide needle.
- Needle biopsy or fine-needle aspiration: The removal of a sample of tissue or fluid from a lymph
node using a thin needle.
- CT scan (CAT scan): A procedure that makes a series of
detailed pictures of areas inside the body, taken from different angles. The
pictures are made by a computer linked to an x-ray machine. A dye may be
injected into a vein or swallowed to help the organs or tissues show up more
clearly. This procedure is also called computed tomography, computerized
tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of
detailed pictures of areas inside the body. This procedure is also called
nuclear magnetic resonance imaging (NMRI).
- X-rays of the chest, bones, and abdomen: An x-ray is a type of energy beam that can go through the body and onto
film, making a picture of areas inside the body.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or
organs and make echoes. The echoes form a picture of body tissues called a
sonogram.
- Radionuclide scan: A procedure to find areas in the body where cells,
such as cancer cells, are dividing rapidly. A very small amount of radioactive
material is swallowed or injected into a vein and travels through the
bloodstream. The radioactive material collects in the bones or other tissues and
is detected by a radiation-measuring device.
The following stages are used for neuroblastoma:
Stage 1
In stage 1, the tumor is in only one area and all of the tumor that can be
seen is completely removed during surgery.
Stage 2
Stage 2 is divided into stage 2A and 2B.
- Stage 2A: The tumor is in only one area and all of the tumor that can be seen
cannot be completely removed during surgery.
- Stage 2B: The tumor is in only one
area and all of the tumor that can be seen may be completely removed during
surgery. Cancer cells are found in the lymph nodes near the tumor.
Stage 3
In stage 3, one of the following is true:
- the tumor cannot be completely removed during surgery and has spread from one
side of the body to the other side and may also have spread to nearby lymph
nodes; or
- the tumor is in only one area, on one side of the body, but has spread
to lymph nodes on the other side of the body; or
- the tumor is in the middle of the body and has spread to tissues or lymph nodes on both sides of the body, and
the tumor cannot be removed by surgery.
Stage 4
Stage 4 is divided into stage 4 and stage 4S.
- In stage 4, the tumor has spread to distant lymph nodes, the skin, or other
parts of the body.
- In stage 4S, the following are true:
- the child is younger than 1 year; and
- the cancer has spread to the skin, liver, and/or bone marrow; and
- the tumor is in only one area and all of the tumor that can be seen may be
completely removed during surgery; and/or
- cancer cells may be found in the lymph
nodes near the tumor.
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