Diagnosis & Staging
Your child’s doctor will do a physical exam first to look for signs of cancer and will ask about your child’s health history. Then the doctor may recommend a number of tests to help identify the type of cancer and see whether it has spread. A urine test or blood test may reveal high levels of certain chemicals that are produced or increased by neuroblastoma. By doing a neurological exam, the doctor can check your child’s nervous system for anything unusual. This exam involves questions about the child’s thinking and movement, and simple tests to see whether muscles, reflexes, and coordination seem healthy.
If the doctor thinks that your child may have neuroblastoma, the doctor will perform a biopsy next to confirm the diagnosis. To perform a biopsy, a doctor removes a small sample of tissue to examine under a microscope. Biopsies can involve surgery or just taking fluid or tissue using a needle, called needle biopsy or fine needle aspiration.
Your child’s doctor will also want your child to have imaging studies, such as an X-ray, ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or bone scan, and an MIBG scan, to see pictures of the inside of the child’s body. This allows the doctor to look for tumors or areas of cancer activity.
Staging refers to the way doctors classify cancer based on where it is in the body. This, along with other factors, helps doctors choose a course of treatment.
Children who have neuroblastoma are considered to be at one of these stages:
Stage 1: This stage applies to children who have a tumor in only one area, and surgeons can remove all of it that’s visible.
Stage 2: This stage is divided into 2A and 2B: - 2A applies to children who have a tumor in only one area, and surgeons cannot remove all of it that’s visible. - 2B applies to children who have a tumor in only one area, which may or may not be completely removed, and cancer cells in nearby lymph nodes.
Stage 3: This stage applies to children who have any one of these:
- Tumor that cannot be removed completely and has spread to the other side of the body and maybe to nearby lymph nodes
- Tumor that cannot be removed completely, is in the middle of the body, and has spread to both sides of the body (either lymph nodes or other structures)
- Tumor in one area on one side of the body and also lymph nodes on the other side of the body
Stage 4: This stage is divided into 4 and 4S.
- Stage 4 applies to children whose tumor has spread to distant lymph nodes or other parts of the body.
- Stage 4S applies when the child is younger than 1 year old and the cancer has spread to the skin, liver or bone marrow, but not to bone. In stage 4S, the primary tumor must be small, it may or may not be completely removed by surgery, and cancer cells may or may not be in nearby lymph nodes (like in Stage 1 or 2 neuroblastoma).
Childhood neuroblastoma is then grouped as low risk, intermediate risk, or high risk. The risk group is based on your child’s age at diagnosis, the stage of the disease, and characteristics of the cancer cells. Your child’s doctor can explain your child’s risk level and how it was determined. More than 90 percent of children with low-risk disease survive. About 70 to 90 percent of those with intermediate-risk disease survive. Children in the high-risk group have a 30 percent chance of survival.