Neuroblastoma is one of the most common childhood cancers, but it is still rare, affecting about 1 in 100,000 children. This type of cancer develops in immature nerve cells in the adrenal glands, neck, chest, or spinal cord.
The recommended treatment for neuroblastoma depends on a child’s age and the size and location of the tumor. Observation, surgery, chemotherapy, radiation, immunotherapy, stem cell transplant, or a combination of these methods can be used to treat neuroblastoma.
Here’s an overview of the different treatment options available for neuroblastoma.
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The tumors in neuroblastoma sometimes disappear on their own. If a tumor is smaller than 5 centimeters and a child is younger than 18 months, an observational approach may be taken because there is a good chance that the tumor will not progress.
Imaging is usually done every six to eight weeks to check if the tumor is growing.
Surgical resection is done to remove the tumor and some of the surrounding healthy tissue. If the tumor has not spread, surgery may be able to remove all the cancer cells.
If cancer has spread, surgery is sometimes recommended to remove some of the cancer cells. Then another type of treatment, such as chemotherapy, can be used to destroy the other cancer cells.
The cancer cells in the tumor that are removed during surgery can be tested to determine the type of tumor. That information can be used to guide treatment.
Sometimes the size or location of the tumor can make surgery too risky. For example, if the tumor is near the lungs or attached to the spinal cord, treatment other than surgery is usually recommended.
The side effects of surgery depend on the location of the tumor. Any surgery can cause reactions to anesthesia and pain.
Chemotherapy drugs target and destroy cancer cells. They also help prevent cancer cells from growing and dividing and can shrink a tumor. Chemo drugs can be taken orally, injected into the muscle, or given through an IV into a vein.
Chemotherapy may be recommended before or after surgery. When given before surgery, it can help shrink the tumor, making it easier for a surgeon to remove. After surgery, chemotherapy helps to clear out any remaining cancer cells.
Your child’s pediatric oncologist will recommend the best chemotherapy options for the specific type and location of the tumor.
The symptoms of chemo can include fatigue, weakened immune system, nausea, vomiting, hair loss, low appetite, and diarrhea.
Immunotherapy drugs boost the immune system to help fight cancer cells. One drug used to treat high-risk neuroblastoma is a monoclonal antibody called dinutuximab. It is sometimes used with drugs that manipulate the immune system as part of immunotherapy.
Dinutuximab works by attaching to the surface of neuroblastoma cells, marking the cancer cells and prompting the immune system to destroy them.
Neuropathic pain and peripheral neuropathy are significant side effects of dinutuximab (in fact, there is a Black Box Warning on the drug for these reactions). Other common side effects include skin rash, flu-like symptoms, weight change, and diarrhea. Allergic reactions to dinutuximab may also occur.
Stem cell transplant
Stem cell transplants can be used with chemotherapy to treat high-risk cancer. Large doses of chemotherapy can destroy stem cells and other healthy cells in the body.
A stem cell transplant after chemo provides fresh stem cells to help the body rebuild healthy cells and recover faster.
For many children, their own stem cells can be collected and used for the transplant. A stem cell transplant can also be performed using stem cells donated by someone else.
Collecting stem cells
Stem cells can be collected by a process called apheresis. Before the procedure, a drug is given to ensure that the stem cells already in the bone marrow move outside the bone marrow and into the bloodstream. When enough cells circulate in the blood to collect, a type of central venous catheter is placed.
Then the child’s blood is passed through a machine that filters the stem cells from the blood. Then the blood flows back into their bodies.
The procedure may take a few hours to complete and may need to be completed over several days. The stem cells are frozen until after chemotherapy, when the transplant is needed.
While the process minimizes the risk of a child’s body rejecting the stem cells, there is still a risk that some of the cancerous neuroblastoma cells may be in the bone marrow or blood. If this is the case, the cancer cells can be collected along with the stem cells and later reinfused into a patient.
Radiation therapy uses high-energy rays, such as X-rays, to destroy cancer cells. The most common form of radiation therapy is external radiation therapy. It uses a machine to focus a beam of radiation from outside the body at the tumor.
Typically, radiation therapy in young children is avoided and is not usually part of a neuroblastoma treatment plan.
The possible side effects of radiation therapy include fatigue, rash, upset stomach, and diarrhea. It can also interfere with normal growth in children.
Neuroblastoma sometimes goes away on its own. If not, there are many ways it can be treated. If your child has been diagnosed with neuroblastoma, the doctor will explain what types of treatment may work for them.
These treatments may include chemotherapy, surgery, or simply “watch and wait” if their doctor thinks the tumor will go away on its own.
A word from Verywell
When your child is diagnosed with cancer, it can be an overwhelming and frightening experience for your entire family. With the support of their care team, you will learn about your child’s treatment options and be guided in making decisions about their care.