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Neuroblastoma is a type of cancer that develops from immature nerve cells found in several areas of the body.
Neuroblastoma mainly affects infants and young children, typically under the age of 5. This cancer occurs when neuroblasts, which are immature nerve cells, grow and divide uncontrollably instead of maturing into nerve cells or disappearing as they normally would. The exact cause of neuroblastoma is often unknown, but it can sometimes be linked to genetic mutations or abnormalities.
Here are some common types as below:
- Localized neuroblastoma
- Advanced or metastatic neuroblastoma
- MYCN amplification
- Non-MYCN amplified neuroblastoma
- Ganglioneuroblastoma
- Ganglioneuroma
Following are the procedure steps:
Diagnosis: Neuroblastoma is diagnosed through a combination of imaging tests, such as ultrasound, CT scans, MRI scans, and nuclear medicine scans (such as MIBG scans), as well as biopsy to examine the tumor tissue under a microscope. Bone marrow aspiration and biopsy may also be performed to check for spread to the bone marrow.
Staging: Once diagnosed, neuroblastoma is staged to determine the extent of the disease spread. Staging may involve imaging tests, bone marrow biopsy, and examination of other organs to assess whether the cancer has spread beyond its original site. The staging system commonly used for neuroblastoma is the International Neuroblastoma Staging System (INSS) or the International Neuroblastoma Risk Group (INRG) staging system.
Treatment planning: Treatment for neuroblastoma is often tailored to the individual patient based on factors such as age, risk classification, and tumor characteristics. A multidisciplinary team, including pediatric oncologists, surgeons, radiation oncologists, and other specialists, collaborates to develop a treatment plan.
Surgery: Surgical removal of the tumor is often the first step in treatment, especially for localized neuroblastoma. The extent of surgery depends on factors such as tumor size, location, and nearby structures involved. In some cases, complete surgical removal may not be feasible due to the tumor's location or spread.
Chemotherapy: Chemotherapy is commonly used to shrink the tumor before surgery (neoadjuvant chemotherapy), to treat any remaining cancer cells after surgery (adjuvant chemotherapy), or to target cancer cells that have spread to other parts of the body. Chemotherapy drugs used for neuroblastoma may include cisplatin, etoposide, doxorubicin, cyclophosphamide, vincristine, and topotecan.
Radiation therapy: Radiation therapy may be used to target and destroy cancer cells, particularly in cases where the tumor cannot be completely removed by surgery or when there is residual disease after surgery. It may also be used to relieve symptoms such as pain or breathing difficulties caused by the tumor.
Immunotherapy: Immunotherapy drugs, such as dinutuximab, may be used in high-risk neuroblastoma to boost the body's immune response against cancer cells. These drugs target specific molecules on the surface of neuroblastoma cells and may be given in combination with other treatments.
Stem cell transplant: High-dose chemotherapy followed by autologous stem cell transplant (using the patient's own stem cells) may be recommended for high-risk neuroblastoma to improve the chance of cure. This procedure allows for the delivery of higher doses of chemotherapy while protecting the bone marrow.
Monitoring and follow-up: After completing treatment, regular follow-up visits are essential to monitor for any signs of recurrence or long-term side effects of treatment. Follow-up may include physical examinations, imaging tests, and blood tests.