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. These tests include bone scans, PET and MIBG scans.
The following stages are used for neuroblastoma:
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 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.
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 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, but not into the bone itself; and
- the primary tumor is in only one area and all of the tumor in that location that can be seen may be completely removed during surgery; and/or
- cancer cells may be found in the lymph nodes near the primary tumor.
Medically Reviewed by a Doctor on 3/19/2014
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