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Neuroblastoma Cancer Diagnosis and Treatment - A Detailed Guide

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The diagnosis of neuroblastoma is based on the combination of several methods, including clinical evaluation, laboratory tests, imaging studies, and biopsy. Neuroblastoma treatment in adults is almost similar to that in children. Neuroblastoma treatment cost depends upon several factors, including the stage of the disease, the location of the tumor, and the treatment options recommended.

What are the Neuroblastoma Cancer Diagnosis Tests?

Following are some of the methods for neuroblastoma diagnosis:

Physical Exam

Oncologists perform comprehensive physical examinations of patients suspected to have neuroblastoma or other underlying disorders that are causing the symptoms. The patients may be asked about the severity and progression of the symptoms. If the patient is a child, the parents are asked about symptoms, the onset of symptoms, and the family history of neuroblastoma. The doctor may check for any palpable mass or swelling in the abdomen. The blood pressure may also be determined, as patients with neuroblastoma have high blood pressure. The strength and movement of the legs are also evaluated, as neuroblastoma growing near the spine may cause muscle weakness in the legs.

Although neuroblastoma may result in enlarged lymph nodes and a high fever, doctors initially recommend checking for infection. Clinicians recommend blood tests, imaging tests, and biopsy in patients strongly suspected of having neuroblastoma or other cancers.

Blood Tests

Blood tests are not the confirmatory tests for neuroblastoma. However, they provide detailed information about the overall health of the patients. Further, blood tests also measure the level of certain substances for diagnosing neuroblastoma. However, the levels of these chemicals may also be elevated in conditions other than neuroblastoma.

An enzyme, Neuron-Specific Enolase (NSE), is elevated in various cases of neuroblastoma. This marker may be used to determine the progression of the disease and treatment response in patients with neuroblastoma. Further, the level of ferritin increases in patients with neuroblastoma.

The serum concentration of the lactate dehydrogenase enzyme is increased if there is any cellular injury or cell death. Patients with neuroblastoma may have elevated levels of the lactate dehydrogenase enzyme.

Chromogranin A is the protein synthesized and released by the neuroendocrine cells. The concentration of this substance may increase in patients with neuroblastoma.

Urine Test

In patients with neuroblastoma, malignant neuroblasts release certain substances detected in urine. Although elevated levels of these substances in urine are not exclusive to neuroblastoma, oncologists may recommend checking them to detect disease progression and treatment response.

Neuroblastoma cells release several catecholamines, such as adrenaline and noradrenaline, resulting in their elevated levels in urine.

The metabolism of neurotransmitters results in several metabolites, such as homovanillic acid and vanillylmandelic acid. Measuring the urine concentration of these substances may be crucial for patients suspected of having neuroblastoma.

Imaging Tests

Imaging modalities play a role in diagnosing and monitoring neuroblastoma and evaluating treatment responses. The choice of imaging tests depends upon several factors, including the patient's age, the tumor's location and spread, and the requirement for specific information about treatment planning.

Ultrasound

Ultrasound is a non-invasive technique that uses non-ionizing radiation. It is a useful imaging modality for neuroblastoma diagnosis, especially in children and infants, where it is well tolerated. It is a preliminary method to evaluate the palpable mass in the abdomen and is especially useful in diagnosing the neuroblastoma of adrenal glands.

CT Scan

CT scans assist oncologists in visualizing tumors, evaluating their characteristics, determining the spread of tumors, and planning the treatment. Determining tumor characteristics, such as shape, size, density, and extent of the disease spread, helps in staging the disease. However, it is important to consider that CT scans use ionizing radiation and, thus, should be used in children with appropriate precautions.

MRI

Oncologists may recommend magnetic resonance imaging for neuroblastoma diagnosis, especially neural involvement and assessing soft tissues. It determines the shape and size of the tumor, along with its association with the surrounding structures. It accurately assesses the extent of the tumor by differentiating it from the surrounding healthy tissues. MRI does not use ionizing radiation. Thus, it is a preferred imaging modality for pediatric patients, especially when repeated imaging is required.

Methyliodobenzylguanine (MIBG scans)

An MIBG scan is an imaging modality used for neuroblastoma diagnosis and management. It is usually recommended with other imaging modalities, such as CT scans, MRIs, and ultrasounds. MIBG is similar to norepinephrine and is taken up by neuroblastoma cells. As MIBG is associated with radioactive iodine, a special camera is used to detect the radiation emitted by iodine.

X-ray

An X-ray scan is less effective than other imaging modalities, such as CT or MRI, in providing detailed images of soft tissues, such as solid tumors or nerves. An X-ray may help detect the tumor in the chest through a chest X-ray. It also assists oncologists in detecting the presence of cancer in the bone through bone scans.

Nuclear Medicine Scans

Nuclear scans include MIBG scans and PET scans. A PET scan helps diagnose neuroblastoma by determining the areas with high metabolic activity. PET scans use a radioactive glucose analog, which is rapidly taken up by the malignant cells. It assists in staging the disease and allows the oncologists to deliver optimal treatment. The PET scan also determines the response to neuroblastoma treatment.


Biopsy

During a biopsy, the doctor obtains a sample of suspected or abnormal tissues and sends it to the laboratory for further investigation. A biopsy helps oncologists confirm the presence of neuroblastoma. Further, the biopsy also provides histopathological characteristics of the sample. It helps in developing an appropriate treatment strategy. The neuroblastoma diagnosis tests through biopsy include needle biopsy and surgical biopsy. In some cases, the biopsy may be guided by various imaging techniques, such as CT scans (CT-guided biopsy) and MRI (MRI-guided biopsy).

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What are the Effective Neuroblastoma Cancer Treatments?

The following are the commonly recommended approaches for neuroblastoma cancer treatment:

Neuroblastoma Surgery

Surgery is the primary neuroblastoma cancer treatment, especially in patients with early-stage disease. The neuroblastoma surgery aims to remove the neuroblastoma tumor as much as possible. The extent of cancer removal depends upon several factors, such as the size of the tumor and its association with surrounding structures. The tumor may be completely or partially resectable.

Chemotherapy for Neuroblastoma

Chemotherapy is used in cases where a complete resection of the tumor is not possible. It is an important component of neuroblastoma cancer treatment in the majority of cases. Chemotherapy involves the administration of anticancer drugs to destroy cancer cells. It may be administered before or after the surgery. Some high-risk neuroblastoma treatments involve the administration of high-dose chemotherapy. Chemotherapy may also be combined with radiotherapy.

Radiation Neuroblastoma Therapy

Radiation therapy is also an effective modality for neuroblastoma cancer treatment. Radiation therapy is used along with surgery or chemotherapy in patients with high-risk neuroblastoma or recurrent neuroblastoma. External beam radiation therapy is usually used for neuroblastoma cancer treatment.

Immunotherapy for Neuroblastoma

Immunotherapy is an emerging modality for neuroblastoma cancer treatment, particularly in cases of high-risk neuroblastoma. Immunotherapy drugs enhance the efficacy of the immune system to detect and destroy neuroblastoma cancer cells. Studies have reported an improvement in survival with some of the immunotherapy drugs.

Stem Cell Transplantation

Stem cell transplantation is also an effective modality for neuroblastoma cancer treatment, especially in cases of high-risk neuroblastoma with or without bone marrow involvement. High-dose chemotherapy is administered after collecting stem cells. Then, these stem cells are injected back into the patients.

Targeted neuroblastoma Therapy

Several targeted therapy drugs are used for neuroblastoma cancer treatment. These drugs interfere with the essential pathways required for the growth and survival of cancer cells. The oncologists may also provide personalized, targeted therapy after obtaining the histopathological characteristics of the tumor. Targeted therapy is usually used for neuroblastoma stage 4 treatment.

Retinoid Neuroblastoma Therapy

Retinoid plays a crucial role in neuroblastoma cancer treatment, especially during maintenance therapy after surgery, chemotherapy, or radiation therapy. This therapy aims to target minimal disease residue and prevent neuroblastoma recurrence.

Neuroblastoma medication

Certain medications, other than chemotherapy, are also used for neuroblastoma cancer treatment. These drugs may stop the flow of blood to the cancer cells, depriving them of essential nutrients and leading to their death.

Iodine 131-MIBG therapy

This is a relatively newer neuroblastoma cancer treatment. It involves the use of a radioactive form of MIBG. The cancerous cells take up this radioactive chemical, which then releases radiation, killing cancer cells. It may sometimes be used with a bone marrow transplant or chemotherapy.

Why Choose HCG for Neuroblastoma Cancer Diagnosis and Treatment?

Neuroblastoma is a childhood cancer and may be fatal if left undiagnosed or untreated. HCG has all the facilities required for the appropriate diagnosis and management of neuroblastoma. Apart from pediatric oncologists, the care team also comprises pediatricians and pediatric surgeons in order to ensure that patients diagnosed with neuroblastoma receive the highest quality care possible. The hospital has advanced facilities for caring after surgery. HCG also offers various services to families, such as counseling services.

Conclusion

Methods for neuroblastoma diagnosis are physical examination, blood tests, urine tests, imaging modalities, and biopsy. The options for neuroblastoma cancer treatment include surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, stem cell transplantation, and MIBG therapy.

Frequently Asked Questions

Does neuroblastoma always come back?

The recurrence of neuroblastoma depends on several factors, including the stage of diagnosis and the histopathological characteristics of the tumor. Usually, high-risk tumors and tumors detected at advanced stages have a high risk of recurrence.

The duration of chemotherapy depends on the classification and stage of the disease. Patients with intermediate-risk neuroblastoma usually have 4 to 8 cycles of chemotherapy that are completed in about 12 to 24 weeks. However, this may vary from one patient to another.

Neuroblastoma is hard to diagnose as most of its symptoms overlap with those of other less serious conditions. Also, in most cases, early-stage neuroblastoma does not manifest symptoms.

Spontaneous mutations, chromosomal aberrations, and congenital anomalies may cause neuroblastoma.

The severity of the pain depends on the location and stage of the disease. For instance, pain may occur in the early stages if the tumor is present on the spine and compressing the nerves. In other cases, pain occurs when the tumor grows and compresses the surrounding tissues. This usually occurs at a later stage.