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Neuroblastoma

Neuroblastoma – General Information

Neuroblastoma is a cancer of the sympathetic nervous system. Its solid tumors, which consists of a lump or mass, commonly begin in one of the adrenal glands, and usually develop in nerve tissues in the neck, chest, abdomen, or pelvis. The cause of Neuroblastoma is unknown, though most people believe that it is an accidental cell growth that occurs during normal development of the adrenal glands. Neuroblastoma is one of the rare human malignancies known to demonstrate regression very rapidly from an undifferentiated state to a completely benign cellular appearance. The disease is the most common cranial solid cancer and usually occurs in infancy and childhood. It is a neuroendocrine tumor, appearing from any neural crest part of the sympathetic nervous system. About 50% of cancer cases occur in children younger than two years old. Sometimes it begins before a child is born. By the time doctors find the cancer, it has usually spread to other parts of the body. The most common site is the abdomen (near the adrenal gland) but can also be found in the chest, neck, pelvis, or other sites. Most patients have widespread disease at diagnosis. Diagnosis of the disease can be complicated. It has been called the “great masquerader” because its symptoms mimic so many other diseases. The syndrome called opsoclonus-myoclonus syndrome, is sometimes a symptom of the cancer, but it is important to know that not all the children with the syndrome carry the disease. That’s why, before the cancer is diagnosed, its spread all over the body.

Neuroblastoma – Symptoms

The symptoms of Neuroblastoma depend of where the cancer began and in what stage of risk had progressed. The first symptoms are most of the times abdominal pain, swelling, and feelings of fullness caused by the pressure that the tumor applies. If the cancer has reached to the bone, the patient may also feel bone pain. If the cancer has spread to the bone marrow, the patient can become anemic, because the level of red blood cells has decreased, and the patient also can get sick easily because of a low red blood cell count, even causing bruises easily because of reduced platelets. Neuroblastoma that has spread to the eye area causes protruding eyes and darkened skin around the eyes. Neuroblastoma can also spread to the skin, producing small lumps, or nodules, and to the spinal cord, which can cause weakness in the arms or legs and even paralysis. In rare cases, symptoms can include sudden, uncontrollable eye movements, causing poor coordination. Some rare symptoms are sudden muscle spasms and contractions that result in jerky movements. Sometimes, the cancer can provoke watery diarrhea. Less commonly symptoms include fever, high blood pressure, swollen legs, ankles, feet or scrotum, fatigue. Most of these signs and symptoms are not specific for the disease and can be seen with other, more common childhood illnesses. It is good for the child to see a doctor as soon as possible, if he encounters one of the symptoms above, and is indicated not to ignore them at all.

Neuroblastoma – Treatment

The way the treatment is applies on the disease, depends on the severity of the disease. Patients often respond in many ways to the possible treatments. In childrens case, the treatment depends mainly on the child's age, the tumor's location, and where the tumor has spread to. Because the tumor spreads quickly to the bone and bone marrow, it requires one or more of the following treatments: chemotherapy, radiation therapy, stem cell transplantation, immunotherapy, and surgery, to remove the tumor. Surgery is the oldest form to treat Neuroblastoma, that’s why most patients choose this way, by removing it. But, if the Neuroblastoma has not progressed to an advanced stage, it can be cured by surgery only, doctors easily removing the tumor that caused the cancer. If the tumor aggravates, surgery is combined with chemotherapy, which can help shrink the tumor, and after the extraction, can be followed by a surgical process to help kill any remaining cancer cells.

Chemotherapy is using drugs to kill cancer cells. These drugs can be delivered orally, in the form of pills, or IV (intravenously), directly into the blood stream through a needle placed into a blood vessel. In chemotherapy, combinations of drugs are usually more effective than just one type of drug by itself. Patients with early stage of Neuroblastoma are often prescribed the drugs known as carboplatin, cyclophosphamide, doxorubicin, and etoposide. Patients that are categorized into a high risk category are often prescribed these drugs in a very high dose in addition to drugs called ifosfamide and cisplatin.
After diagnosis, the patient must complete 6 to 12 weeks of chemotherapy and up to 24 weeks for more severe cases. Immunotherapy consists in getting the body's immune system, including white blood cells, to fight the cancer. Radiation therapy uses a large amount of x-rays, which are high-energy particles or waves, to kill cancer cells, when the disease is in a severe stage. Radiation therapy may be used to try to cure or control the disease. It can be used before surgery to shrink a tumor or after surgery to prevent the cancer from regrowing. In advanced cancer, radiation therapy may be used to treat symptoms that are caused by the cancer, such as pain. The patient suffering from Neuroblastoma usually needs to see a radiologist everyday for a week or two in order to have this procedure done.

Bone marrow is the tissue found inside bones. The bone marrow in the hips, breastbone, ribs, skull, and spine contains stem cells. These bone marrow stem cells make blood, including red blood cells, white blood cells, and platelets. Under certain conditions, bone marrow stem cells circulate in the bloodstream, and a special machine can collect the stem cells from the blood. Stem cell transplants are used for some patients whose bone marrow, because of the stage of the disease or treatment, no longer produces enough blood cells. Most of stem cell transplants use the patients' own stem cells.


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