Morning Report

Ashley Ellsworth
November 3, 2010
Neuroblastoma

 3rd most common childhood cancer (after

leukemia and brain tumors)
 Most common solid extracranial tumor
 Most common cancer in infants <12 months
 >600 cases diagnosed a year
 15% of pediatric cancer mortalities
Signs and Symptoms
 Abdominal mass
 Abdominal pain
 Proptosis
 Periorbital ecchymoses
 Horner Syndrome
 Back pain
 Opsoclonus myoclonus ataxia
 Secretory diarrhea
 Systemic symptoms
 Bone pain
 Anemia
 Hypertension
Location

 Sympathetic nervous system

 Adrenal gland (40%)
 Abdominal sympathetic ganglia (25%)
 Thoracic sympathetic ganglia (15%)
 Cervical sympathetic ganglia (5%)
 Pelvic sympathetic ganglia (5%)
Diagnosis
 CBC abnormal if bone marrow involvement
 Vanillylmandelic acid (VMA) and homovanillic acid
(HVA)
 Defective synthesis of catecholamines -> accumulation of
intermediates
 Abnormal in 90% of cases
 Bone Marrow Aspirate and biopsy
 CT/MRI of abdomen, imaging of chest
 Bone scan
 Tissue biopsy
Staging
 Stage 1: localized tumor with complete gross excision
 Stage 2A: localized tumor with incomplete gross excision. Negative
ipsilateral lymph nodes
 Stage 2B: localized tumor with or without complete gross excision.
Positive ipsilater lymph nodes. Negative contralateral lymph nodes
 Stage 3: Unresectable unilateral tumor, infiltrating across midline, +/-
regional lymph node involvlement. Localized unilateral tumor with
contralateral regional lymph node involvement. Midline tumor with b/l
extension.
 Stage 4: Primary tumor with dissemination to distant lymph nodes,
bone, bone marrow, liver, skin and/or other organs.
 Stage 4S: Localized primary tumor with dissemination limited to skin,
liver, and/or bone marrow (limited to infants <1 yr).
Treatment
 Dependent on age and stage
 Surgery alone
 Surgery and chemotherapy
 Radiation therapy is reserved for
unresectable tumors or those unresponsive
to chemo
 Observation
 High rate of spontaneous regression in infants
with 4S
Prognosis

 Extent of metastatic spread is most important

factor
 Higher stage disease more commonly
diagnosed in older children
 Five-year survival rates
 Children < 1 yr: 83%
 Children 1-4 yrs: 55%
 Children 5-9 yrs: 40%

Information taken from UpToDate: Clinical presentation, diagnosis, and staging evaluation of neuroblastoma
Treatment and prognosis of neuroblastoma
Epidemiology, pathogenesis, and pathology of neuroblastoma