Cancer Information

Neuroblastoma Diagnosis

  • Screening is performed through urine test for vanillylmandelic acid (VMA) and homovanillic acid (HVA). Seventy-five percent to 90% of cases of neuroblastoma excrete these substances into the urine. VMA levels above 25μg/mg creatinine and an HVA levels greater than 32μg/mg creatinine are considered abnormal.

  • CT scan or MRI to determine the size of the tumor.

  • Bone scans and bone marrow aspiration to rule out metastasis.

  • Biopsy of the tumor confirms the diagnosis.


Treatment of neuroblastoma depends on the stage of the The risk of progression of the tumor causing morbidity and mortality is gauged based on the stage of the tumor, the age of the child at diagnosis, and tumor biology. The biological features considered are the Shimada histology, amplification of the N-MYC gene, and the number of chromosomes in tumor cells.

Surgical resection of the tumor, Chemotherapy and radiotherapy are used in different combinations.

1.For localized tumor which is resectable -  either of these three options is used.

  •   Surgery to remove the cancer

  •    Surgery plus adjuvant chemotherapy

  •  Surgery plus radiation therapy.

2.Localized Unresectable Neuroblastoma -

  • Initial surgical removal of as much of the cancer as possible followed by chemotherapy.

  • A second surgery may be performed to remove any residual cancer and radiation therapy may then be given.

3.Regional Neuroblastoma

  • Surgery to remove the cancer followed by Chemotherapy

  • Chemotherapy with or without radiation therapy to reduce the tumor, followed by surgery

4.Disseminated Neuroblastoma -

  • Multi-drug chemotherapy with or without surgery and/or radiation therapy .

  •  Chemotherapy followed by peripheral stem cell transplantation and 13-cis retinoic acid.

Chemotherapy agents- These are given in cycles and include Cyclophosphamide, Adriamycin, ifosfamide, cisplatin, carboplatin, vincristine, doxorubicin, and etoposide.

Radiation Therapy- Usually used for decreasing the size of a tumor or after surgery. Also used for treatment of bone metastasis. In some cases where tumor is causing Chord compression, urgent radiotherapy may be helpful in rapidly decreasing the size of the tumor and alleviate the compression. Prognosis for neuroblastoma is usually good for stage 1 and stage 2 diseases.