Neuroblastoma in Children

What are the signs and symptoms of neuroblastoma?

Although neuroblastoma is sometimes present at birth (congenital), children show symptoms only as the tumor grows. The symptoms a parent notices depends on the location and size of the tumor.

The most common site for neuroblastoma is in the adrenal glands, located on top of the kidneys. The tumors can also develop in nerve cells in the neck, chest, abdomen, pelvis or along the spine.

Some common neuroblastoma symptoms may include:

• A mass in the abdomen that can be painless or cause pain or discomfort
• Changes in urination or bowel movements
• Pain or weakness in parts of the body
• Bone pain
• Increased bruising or bleeding
• Tiredness, dizziness or shortness of breath
• Swollen or bluish skin around the eyes
• Stomach pain and feelings of fullness
• Headaches or dizziness
• A mass in the chest found on X-ray
• Rarely, a swollen, typically painless, lump that you can see or feel under the skin

How do we diagnose neuroblastoma in children?

First, we’ll examine your child fully, including extra attention to the areas that often show symptoms. Your doctor may also test your child’s urine for chemical levels that may be increased by a neuroblastoma.

If your child has an obvious mass in their body, bone changes or lump under their skin, your doctor may want to perform a biopsy. A biopsy is a surgical procedure done while your child is under general anesthesia to take a small sample of tissue to test for cancer. This can be done by a surgeon or an interventional radiologist depending on what’s best for your child. Your child will not be awake or feel any pain during the procedure.  A pathologist (a doctor who specializes in examining tissue) looks at the tissue under a microscope to determine what kind of cells it contains. Generally, it takes a couple days or more for the pathologist to gather all the information needed to make a diagnosis.

What can I expect after a neuroblastoma diagnosis?

If the biopsy leads to a neuroblastoma diagnosis, your child’s doctor will do some additional tests known as tumor staging. These tests identify if the tumor has spread to other parts of the body. Understanding the stage of the tumor helps your child’s doctor determine the most effective treatment.

We use a variety of imaging tests and scans for tumor staging. Tests may include:

• X-ray
• CT scan
• MRI
• PET scan 
• MIBG scan: This test requires an injection of a very small amount of radioactive dye to help us see cancer cells during a scan.
• Bone marrow aspiration and biopsy: We use a needle to remove bone marrow (a soft, spongy tissue found inside the bones). This allows us to see if the neuroblastoma has spread into the bone marrow.

Why choose Children’s Colorado for neuroblastoma testing?

We understand that many of the imagining tests used to diagnose neuroblastoma can be challenging for kids. That’s why our imaging team and child life specialists ensure testing is as comfortable and kid-friendly as possible. This can include calming techniques, light sedation or medication to help your child feel more relaxed, or in some cases, general anesthesia. We also utilize imaging machines that use the smallest amount of radiation possible to help protect your child.

In some cases, we can diagnose neuroblastoma during pregnancy using ultrasound — usually in your third trimester. Although we can’t treat neuroblastoma before birth, the world-renowned maternal fetal specialists in our Colorado Fetal Care Center can help monitor your pregnancy and partner with our multidisciplinary team of pediatric specialists to ensure your baby can get the treatment they need as soon as possible after delivery. Often, treating neuroblastoma in babies leads to better outcomes.

How do we treat neuroblastoma?

How we treat neuroblastoma cancer in children depends on the child’s age, the size, location of the tumor and whether it has spread. The specialists in our Center for Cancer and Blood Disorders work together to find the most effective treatment for your child.  

Treatment for neuroblastoma can involve one or more therapies, including: 

• Surgery: During a surgical biopsy, your child’s doctor will try to remove as much of the neuroblastoma as possible. For some tumors that have not spread, we may be able to successfully remove the entire neuroblastoma.  
• Chemotherapy: Often neuroblastoma treatment includes chemotherapy – usually after biopsy. Chemotherapy drugs help shrink the tumor and treat any remaining cancer cells or keep them from growing and spreading.  
• Radiation: When necessary, we use these high-powered beams of energy to target and kill cancer cells. Our pediatric radiation oncologists understand the need to balance effective radiation treatment with your child’s safety. We use the safest, most advanced radiation treatments to care for kids with neuroblastoma.  
• Bone marrow transplant: A bone marrow transplant is an option for children older than 18 months whose neuroblastomas have spread to other locations or those with certain genetic changes. We pair this with high doses of chemotherapy and an infusion of their own stem cells. This process is for aggressive types of neuroblastoma.  
• MIBG therapy: We use this specialized treatment for certain types of tumors, including neuroblastoma. MIBG therapy uses infusions of radioactive iodine, given through an IV, that spreads throughout the body to target and kill cancer cells. We often use this when the neuroblastoma doesn’t respond to therapy or comes back after treatment.

Why choose us for treatment of pediatric neuroblastoma?  

Our Center for Cancer and Blood Disorders is one of the largest pediatric cancer programs in the country. We’re the only pediatric center in the region providing personalized care for children and young adults with cancer and blood disorders from birth through adulthood. When your child is diagnosed with cancer, you want to find a team that’s experienced in treating cancerous tumors and has access to the most current and effective treatment options. You’ll find that here.

Each year at Children's Colorado, we diagnose and treat more than 300 children with cancer. Our solid tumor team meets every week to decide the best treatment for each child. Our solid tumor board also will review your child’s health and test results when needed, as well as the latest research to find the best treatment options.

We’re also well-versed in the most advanced treatment options. We’re one of only 25 hospitals in the country offering MIBG therapy and we’ve performed more than 1,100 bone marrow transplants for children.

Our pediatric cancer team is actively involved in research and clinical trials to better understand and more effectively treat neuroblastoma, both locally and internationally. Our team maintains leadership roles within the Children’s Oncology Group, an international group that develops trials for newly diagnosed and relapsed patients with neuroblastoma. Through our Experimental Therapeutics Program, we also participate in clinical trials for children with neuroblastoma including the New Approaches to Neuroblastoma Therapy (NANT) consortium and the National Cancer Institute’s Pediatric Early Phase Clinical Trials Network (PEP-CTN). This all helps us bring the latest in neuroblastoma treatment to kids in our care.

Helpful resources

Cure Search for Children’s Cancer has more information about childhood neuroblastoma.