Neuroblastoma: Symptoms, Stages And Treatments

This type of cancer arises from neuroblasts, nerve cells in their early stage.

Neuroblastoma

Cancer has been a terrifying word for many years for most people. It refers to one of the diseases that continues to pose a great challenge to medicine today. There are many types of tumor that can appear in our body, being possible that they are generated in any type of tissue and at any age.

One such type appears in neuroblasts, immature cells of the nervous system. We are talking about neuroblastoma, a rare cancer that generally appears in children, being one of the most common in infants and under four years of age (in fact it is the most common before two years of age).

Neuroblastoma: definition and symptoms

The term neuroblastoma refers to a rare type of cancer, but which is nevertheless the most common in childhood before two years of age. It is a type of embryonic tumor in which there is an accelerated, uncontrolled and infiltrative growth of the precursor cells of neurons and glia : neuroblasts.

These cells are formed during the gestation of the individual, appearing and forming part of the neural plate to later develop and differentiate during fetal development until they form the cells of our nervous system (both neurons and neuroglia). In other words, they are the precursors of our nerve cells.

Although most neuroblasts transform into nerve cells during fetal development, occasionally some children can keep some of them immature even after birth. They generally disappear over time, but sometimes for some reason they can grow out of control and become a tumor.

They generally appear in the ganglia or in the nervous bundles of the autonomic nervous system, although this may imply that they can practically appear anywhere in the body. The areas where it appears most commonly are in the adrenal glands (being its most common point of origin), abdomen, medulla or chest.

Symptomatology

One of the difficulties of this disease is that the symptoms that it can arouse are initially very unspecific, making it easy to confuse it with other disorders or even go unnoticed. In fact, in many cases they are only observed when the tumor has already grown, so it is relatively frequent that it is only detected once it has even metastasized.

The most frequent is that they appear alterations of the appetite, fatigue and weakness. There is also usually fever, pain and gastric alterations. Other symptoms will depend largely on the area in which the tumor appears. For example headaches, dizziness or vision problems are common if there is brain involvement, bruises in the eyes or the existence of inequality between both pupils in terms of size. In addition, problems appear when urinating, moving, maintaining balance, as well as tachycardia, bone and / or abdominal pain or respiratory problems are also common.

The stages of neuroblastoma

As in other cancers, neuroblastoma can be observed in a series of phases and stages in which the tumor can be located according to its degree of malignancy, location, and infiltration into other tissues. In this sense we can find:

  • Stage 1: The tumor is localized and very limited. Its surgical removal can be simple
  • Stage 2: The tumor is localized but nearby lymph nodes are seen to have cancer cells. Removal is complicated.
  • Stage 3: In this stage, the tumor is advanced and large, and cannot be resected or such a resection would not eliminate all the cancer cells
  • Stage 4: Stage 4 indicates that the tumor has advanced and has infiltrated different tissues, metastasizing. Despite this, in some cases of children under 1 year of age (which we would call stage 4S), the subject may recover despite said metastasis.

What are your causes?

The causes of the appearance of a neuroblastoma are currently unknown, although the existence of genetic problems that may generate the appearance of this problem is proposed . In fact, in some cases there is a family history, so that it is possible to speak of a certain transmissibility in some cases (although it is not a majority).

Treatment

Treating a neuroblastoma successfully depends on the presence of certain variables, such as the location of the tumor, its stage and its level of spread, the child’s age or resistance to previous treatments.

In some cases, treatment may not be required, since it has been observed that sometimes the tumor disappears on its own or turns into a benign tumor. With regard to the rest of cases, the removal of the tumor may be sufficient, but chemotherapy and / or radiotherapy (especially in those cases in which there is some spread) may also be required to cure the disease or reduce its growth rate.

In cases where chemotherapy is carried out in an intensive way, which stops cell growth, it is usual that before doing so, the patient’s own stem cells are collected for their subsequent reintroduction into the body once chemotherapy has concluded. A transplant of the child’s own bone marrow can also be done (removing it before the application of the treatment). On those occasions when the tumor is resected, immunotherapy can then be carried out by injecting antibodies that allow the patient’s own immune system to fight and destroy the remains of tumor cells.

But regardless of how effective a treatment may or may not be, it must be borne in mind that it is a type of tumor that especially affects young children, so it must be done taking into account what the risk may entail for a minor. fact of undergoing certain treatments. Surgical interventions, relatively frequent visits to the doctor, check-ups, injections, the use of therapies such as radio or chemotherapy or possible hospital stays can be extremely aversive for the child and generate great fear and anxiety.

It is necessary to try to make the minor’s experience as less traumatic and aversive as possible. For this, different techniques can be applied, such as Lazarus’ emotional staging technique, making the child, for example, visualize himself as a superhero with whom he identifies and who is fighting evil through the treatment.

The psychoeducation of parents is also important, since it allows them to raise the issue, clear and express doubts and feelings, learn strategies to try to handle the situation and in turn contributing to the fact that the emotional reactions of parents do not generate in turn generate negative anticipations and a higher level of fear and anguish in the minor. It would also be useful to go to support groups or mutual help, in order to learn about other cases and share experiences with subjects who have suffered the same problem.

Forecast

The prognosis for each case can vary greatly depending on various variables. For example, it is possible that in some cases the tumor may become a benign tumor or even disappear on its own, especially when it occurs in very young children.

However, in many other cases if it is not treated or is detected late, it is possible that metastasis occurs. In fact, in a vast majority of cases, the diagnosis is made when this has already occurred.

Treatment is generally effective in non-disseminated tumors, although when there are already metastases, treatment is usually much more complex. One aspect to take into account is that the younger the child, the less likely there may be recurrences in the future.

With regard to survival, generally in patients with low risk (stages 1 and 2) the prognosis is very positive after treatment, with a 95% survival rate. Those who are at intermediate or moderate risk (2-3) also have a very high survival rate (more than 80%). However, unfortunately in high-risk patients (with dissemination, the tumor being in stage 4) the survival rate is reduced to 50%.

Bibliographic references:

  • Dome, JS, Rodriguez-Galindo, C., Spunt, SL, Santana, VM (2014). Pediatric solid tumors. In: Niederhuber, JE, Armitage, JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; chap 95.
  • Maris, JM (2010). Recent Advances in Neuroblastoma. N. Engl. J. Med., 362: 2202-2211.
  • Modak, S, Cheung, NK (2010) Neuroblastoma: Therapeutic strategies for a clinical enigma. Cancer Treat Rev., 36 (4): 307-317.

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