What is neuroblastoma?
One of the common childhood cancers (in the group of malignant solid tumors). It arises from neural crest elements and may be found in the neck, chest, abdomen or pelvis, in particular, involves the adrenal glands and the sympathetic nervous system.

Is it serious disease?
This is a malignant tumor that is usually aggressive and commonly presents at the advanced stage. Early staged disease tends to be without symptoms and often undiscovered. Most if untreated will lead to life-threatening consequences.

How is neuroblastoma usually detected?
Common symptoms include masses or swellings in the regions involved. Persistent fever, bone pain, swelling and bruise around the eyes and in the head are signs of disease spread. Initial consultation with one’s family doctor or paediatrician when symptoms arise is highly recommended before referral to the relevant specialists (paediatric oncologist or paediatric surgical oncologist). Further tests usually include imaging scans (like ultrasonography, CT scan, MRI) and bone marrow tests.

How is neuroblastoma treated?
Patients diagnosed with neuroblastoma undergo a set of evaluations to be assigned a risk-group and the necessary treatment protocol. Various combinations of surgery, chemotherapy, peripheral stem cell transplantation, radiotherapy and MIBG therapy may be recommended. Most neuroblastomas respond to chemotherapy. When it is not feasible to perform initial surgery to remove the tumor, chemotherapy is used as the first treatment instead. To date, many treatment protocols have been tested with published safety and outcome features.

What is spontaneous regression in neuroblastoma?
This is a unique characteristic in a particular subgroup. Neuroblastoma is well-known of its ability to undergo spontaneous regression (disappears without treatment). This is most often observed in young infants (below 18 months of age) with stages 1, 2 or 4S, and without MYCN amplification. This is a special group of patients where non-treatment with regular surveillance may be chosen. Strict selection criteria has to be applied.

Why is neuroblastoma surgery unique?
Surgery to remove neuroblastoma is usually very challenging because of its proximity to important critical blood vessels like aorta, inferior vena cava, arteries supplying the kidneys, intestines, stomach, liver etc. These blood vessels are often encased or trapped within the tumor. Complete surgical resection may risk injury to these blood vessels, leading to end-organ damage. Improved surgical techniques coupled with better understanding of the biological characteristics of neuroblastoma, complete tumor removal can be achieved safely. Good surgery is believed to be beneficial to these patients’ survival.

What are the factors used to predict the patient’s outcome?
Age at diagnosis of less than 18 months, low stages, favourable histology and absence of NMYC amplification are associated with good outcome.

Will my child’s siblings develop neuroblastoma as well?
The probability of inherited neuroblastoma is extremely low. Antenatal ultrasound scan may sometimes be able to detect a neuroblastoma in the unborn child. You are advised to discuss your concerns with your oncologist.