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Neuroblastoma
Neuroblastoma
is the most common malignant tumors in infancy. Nearly 50% of
the cases occur in first two years and about 75% before 5 years
of age and rarely
found in children older than 10 years. There have been
cases when the tumor was diagnosed at birth with metastasis to
placenta. Incidence is around 9 per million. Some cases of
neuroblastoma have familial incidence and follow an autosomal
dominant pattern of inheritance.
These
tumors arise from primitive neuroblasts. Nearly
33% of neuroblastomas originate in the adrenal glands, another
33% begin in the sympathetic nervous system ganglia of the
abdomen, and the rest start in sympathetic ganglia of the chest
or neck or the parasympathetic ganglia in the pelvis and the
spinal cord.
Sign
and Symptoms:
-
Abdominal
mass
-
Compression
of surrounding structure like respiratory distress, cough
can occur due to mediastinal involvement.
-
Spinal
chord compression can cause paraplegia.
-
Bony
metastasis might cause - bone pains, proptosis (bulging eye)
-
The
paraneoplastic syndrome may occur due to secretion of
hormones (catecholamines) by the tumor and may cause -
Diarrhea, flushing, tachycardia, excessive sweating. Rarely
muscle weakness (myaethenia gravis), myoclonus
(brief, shock-like muscle spasms), and opsoclonus
(irregular, rapid, horizontal and vertical eye movements)
might occur.
Stages
of Neuroblastoma -
Stage
1:
The cancer is on one side of the body and
is localized (hasn't spread). All visible tumor is totally
removed by surgery. Lymph nodes enclosed within the tumor may
contain neuroblastoma cells, but lymph nodes outside of the
tumor should be free of cancer.
Stage
2A: The
cancer is on one side of the body and is localized, but because
of its size, location, or relationship to other organs, it
cannot be totally removed by surgery. Lymph nodes
enclosed within the tumor may contain neuroblastoma cells, but
lymph nodes outside of the tumor should be free of cancer.
Stage
2B:
The cancer is on one side of the body, is
localized, and may or may not be able to be totally removed by
surgery. Lymph nodes outside the tumor contain
neuroblastoma cells, but the cancer has not spread to lymph
nodes on the other side of the body.
Stage
3:
The cancer cannot be completely removed by surgery. It has
crossed the midline to the other side of the body. It may or may
not have spread to nearby lymph nodes. Or, it is on one side of
the body but has spread to lymph nodes that are relatively
nearby but on the other side of the body.
Stage
4:
The cancer has spread to distant sites such
as lymph nodes, bone, liver, skin, bone marrow, or other organs.
But the child does not meet criteria for stage 4S.
Stage
4S (also called "special" neuroblastoma): The
child is younger than 1 year old. The cancer is on one side of
the body and is localized. It may have spread to lymph nodes on
the same side of the body, but not to nodes on the other side.
Neuroblastoma has spread to the liver, skin, and/or the bone
marrow. However, no greater than 10% of marrow cells may be
cancerous, and imaging studies should not show bone damage.
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