Neuroblastoma

Also called: childhood neuroblastoma, pediatric neuroblastoma

What is neuroblastoma?

Neuroblastoma is a very rare type of cancerous tumor that almost always affects children.

  • Neuroblastoma develops from nerve cells in the fetus called neuroblasts. Usually, as a fetus matures and after birth, the neuroblasts develop normally. Sometimes they become cancerous, causing neuroblastoma.
  • Neuroblastoma can be inherited (passed down in families).
  • Neuroblastoma tumors generally develop in the adrenal glands (located on top of the kidneys), where neuroblasts are most commonly found. But neuroblastoma can also begin in or spread to other areas including the chest, the spine or spinal cord regions and the abdomen.

How common is neuroblastoma?

  • Neuroblastoma accounts for 7 to10 percent of childhood cancers.
  • Each year, 800 new cases are diagnosed in the United States.
  • It occurs slightly more often in boys than in girls.
  • Neuroblastoma accounts for 50 percent of all cancers in infants, making it the most common tumor in infants younger than 1 year.
  • Most children with neuroblastoma are diagnosed before age 5.
  • The number of cases of neuroblastoma is about the same worldwide, so environmental factors do not seem to play a role.

What are the symptoms of neuroblastoma?

Neuroblastoma is usually discovered when a tumor or lump appears. Very rarely, the discovery is made using fetal ultrasound.

Symptoms of neuroblastoma may include:

  • A hard, painless mass in the neck
  • Stomach pain
  • Feeling irritable
  • Decreased appetite
  • Leg weakness

How is neuroblastoma treated?

Treatment depends on the patient’s age and how much the disease has spread:

  • Surgery—is used if the tumor has not spread to other parts of the body. Surgical removal usually means the patient will remain free of neuroblastoma.
    • If the tumor affects the spinal cord, chemotherapy is used right away instead of surgery, which could cause paralysis.
    • Chemotherapy and other medicines may also be used instead of surgery when neuroblastoma has already spread by the time it is diagnosed.
  • Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
    • Chemo may be injected into the bloodstream, so that it can travel throughout the body.
    • Some chemo may be given by mouth.
    • Combination therapy uses more than one type of chemo at a time.

Radiation therapy may be combined with chemotherapy.

  • Radiation therapy—uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing:
    • External radiation uses machines outside the body to deliver the X-ray dose.
    • Internal radiation uses needles, seeds, wires or catheters (tubes) to deliver the radiation directly into or close to the cancer.

High-risk patients are given more intense treatments. Patients with neuroblastoma are considered high-risk when the tumor cannot be surgically removed and has spread:

  • To lymph nodes near the tumor;
  • To other areas near the tumor, but not to other parts of the body; or
  • To distant lymph nodes in other parts of the body such as bones, bone marrow, liver, skin or other organs.

For high-risk patients, higher-dose chemotherapy and immune therapy combined with a stem cell transplant may be used.

  • Stem cell transplant—includes replacing blood-forming cells in the bone marrow that have been killed by chemo and/or radiation therapy:
    • A stem cell transplant gives the patient new immature blood cells from a donor’s blood or bone marrow. These cells grow into healthy blood cells to replace the ones the patient lost.
    • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
    • Immune therapy with an antibody called GD2 along with GM-CSF and Il-2 is given at the end of therapy.

What are the survival rates for neuroblastoma?

  • Infants have a better chance than older children of remaining free of neuroblastoma after treatment.
  • Based on categories of risk, these are the five-year survival rates for neuroblastoma:
    • For low-risk patients: about 95 percent
    • For moderate-risk patients: between 80 and 90 percent
    • For high-risk patients: about 50 percent

Why choose St. Jude for your child’s neuroblastoma treatment?

  • St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
  • St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
  • The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
  • Basic scientists at St. Jude continue to investigate what factors cause neuroblastoma cells to form in the first place.
  • St. Jude researchers identified the first gene mutation related to a chronic and often fatal form of neuroblastoma that typically strikes teens and young adults. The finding provides the first clue about the genetic basis of the link between treatment outcome and age at diagnosis.
  • A new anti-neuroblastoma antibody is currently being made at St. Jude to provide another tool for destroying any remaining microscopic disease.
  • St. Jude has a new study that combines the antibody GD2 with chemotherapy. This combination may increase the survival for children with neuroblastoma.
  • We are using new imaging techniques to see if the tumor has spread or responded to therapy.
  • St. Jude scientists are researching new ways to remove tumor cells from bone marrow by using drug combinations or laboratory methods to filter out the tumor cells.

Associated Clinical Trials

ANBLB1: Biomarkers in Tumor Tissue Samples From Patients With Newly Diagnosed Neuroblastoma or Ganglioneuroblastoma

Neuroblastoma Biology Studies

Diseases Treated:

Neuroblastoma

Eligibility:

This is a non-therapeutic clinical trial that is only open to St. Jude patients.

  • All newly diagnosed suspected:
    • neuroblastoma,
    • ganglioneuroblastoma, or 
    • ganglioneuroma (maturing subtype) patients
  • Less than or equal to 21 years of age
  • Seen at Children's Oncology Group (COG) institutions
View Trial

NB2012: Therapy for Children with Advanced Stage High-Risk Neuroblastoma

Anti-GD2 Monoclonal Antibody Hu14.18K322A and Combination Chemotherapy before Autologous Stem Cell Transplant and Radiation Therapy in Treating Younger Patients with Previously Untreated High-Risk Neuroblastoma

Diseases Treated:

Neuroblastoma

Eligibility:

  • Participant is < 19 years of age at the time of study enrollment.
  • Participant has newly diagnosed, advanced stage, high-risk neuroblastoma.
  • Participant has histologic proof of neuroblastoma or positive bone marrow for tumor cells with increased urine catecholamine.
  • Participant has adequate renal and hepatic function.
View Trial

NBL1232: Response and Biology-Based Risk Factor-Guided Therapy in Treating Younger Patients With Non-High Risk Neuroblastoma

Utilizing Response- and Biology-Based Risk Factors to Guide Therapy in Patients with Non-High-Risk Neuroblastoma (ANBL1232)

Diseases Treated:

Neuroblastoma, ganglioneuroblastoma

Eligibility:

  • Participant has been enrolled on ANBLB1 (ANBL00B1).
  • Participant has newly diagnosed MYCN non-amplified neuroblastoma or MYCN non-amplified ganglioneuroblastoma.
  • Participant is less than 12 months (Group A) and less than 18 months (Group B and Group C) of age at diagnosis.

 

View Trial

SJGD2: Monoclonal Antibody Therapy in Treating Younger Patients with Relapsed or Refractory Neuroblastoma, Osteosarcoma, or Melanoma

A Phase I Trial of the Humanized Anti-GD2 Antibody(HU14.18K322A) in Children and Adolescents with Neuroblastoma, Osteosarcoma, Ewing Sarcoma and Melanoma

Diseases Treated:

Neuroblastoma, osteosarcoma, melanoma or Ewing sarcoma

Eligibility:

  • Up to 21 years of age
  • Diagnosis of neuroblastoma, melanoma, osteosarcoma  or Ewing sarcoma that has come back or did not respond to previous treatment
  • Any uncontrolled infection
View Trial

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