Neuroblastoma is the most common solid cancerous tumor of infancy and childhood other than brain tumors. It develops from the immature fetal nerve cells called neuroblasts. The tumor usually develops in the adrenal gland present in the abdomen. Other sites of its occurrence are nerve tissues of neck, spinal cord, and chest.
Neuroblastoma is mostly present at birth but its manifestations become noticeable only as the tumor grows and compresses the adjacent structures. Some neonatal neuroblastoma present with spinal cord compression. This may need urgent diagnosis and treatment for relieving cord compression.
Neuroblastoma is diagnosed with various imaging techniques such as CT scan, MRI, bone scan etc. Treatment includes surgery, chemotherapy, radiation and supportive care.
What Causes Neuroblastoma In Babies?
As with any other cancer, the exact cause of neuroblastoma is not known. It is not an infectious disease and does not spread to other people by touch or through air. Cancer begins due to genetic mutation. Normally the cells grow to certain extent and then stop. However, because of mutation the cell growth is uncontrollable and they multiply to develop a tumor.
Neuroblastoma originates from neuroblasts.These are immature nerve cells during the fetal growth in the womb. As the fetus develops in the womb, neuroblasts mature to form nerve cells and cells of adrenal gland. Majority of neuroblasts mature at the time of birth, but some cells still remain. They disappear soon after birth. However, few of them may turn into a tumor called neuroblastoma.
At least 1 percent of neuroblastomas occur due to hereditary. Hence a child is at risk of developing this cancerous tumor if there is a strong history of neuroblastoma in the family. The disease is slightly more common in boys as compared to girls. Certain environmental factors are also suspected for its development such as exposure to electromagnetic fields, mother consuming alcohol during pregnancy etc.
Signs And Symptoms Of Neuroblastoma In Babies
Following are the symptom of neuroblastoma. However, every child may experience different set of symptoms as this depends on the area involved. The symptoms also depend on the size of tumor and if it has metastasized. In a child less than one year, at least 50 percent of tumors are in abdomen and 30 percent are in chest. In older children 75 percent neuroblastoma are in abdomen and 15 percent are in chest. Neuroblastoma usually is not found in teenagers. Below are given symptoms of neuroblastoma in babies:
- When neuroblastoma is present in abdomen, the tummy appears to be swollen. The child often has other symptoms such as constipation and difficulty in passage of urine due to compression from growing tumor from the adrenal gland. The tumor can be appreciated on examination of abdomen as a solid mass. It may be tender to touch.
- Neuroblastoma in chest may present with wheezing, pain in chest and difficulty in swallowing.
- Neck neuroblastoma appears as a solid lump in neck. It may cause difficulty in breathing and swallowing. This tumor can also produce other ocular features such as droopy eye, small sized pupil etc.
- Sometimes the neuroblasts remain under the skin. They develop into blue colored lumps under the skin.
- Spinal cord neuroblastoma produces weakness in lower legs, unsteady gait, and retention of urine or involuntary urination. It may also cause backache in toddlers.
- High blood pressure is often seen in adrenal gland neuroblastoma.
Diagnosis And Treatment Of Neuroblastoma
For diagnosis of neuroblastoma, the doctor will clinically examine the child. He will recommend certain tests which include blood and urine test. Blood tests include complete blood count, kidney function test. Imaging techniques such as ultrasound, CT scan and MRI will help to evaluate the primary tumor, its size and extent of its spread. Bone scan may be needed to detect the spread of cancer to other parts of the body. In certain cases bone marrow examination is also performed.
Once the diagnosis is made, the doctor will plan out the treatment. He may consider several aspects before considering any specific treatment. This includes the age of child, the size of tumor, its spread in other areas, and overall health of the child. Treatment consists of surgical resection of the tumor in a low risk neuroblastoma. Whether the tumor can be completely removed will depend on its extent of spread and involvement of other major organs.
During surgery the surgeon will try to remove as much part of tumor as possible. He may also remove the draining lymph nodes. Chemotherapy is used before surgery procedure to shrink the size of tumor. Radiation therapy is another option when surgery and chemotherapy may not be helpful. This may be used in severe form of neuroblastoma. Other modes of treatment include stem cell therapy and immunotherapy.