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Definition of neuroblastoma:

Cancer that arises in immature nerve cells and affects mostly infants and children. 

Neuroblastoma is a disease in which malignant (cancer) cells form in nerve tissue of the adrenal gland, neck, chest, or spinal cord.

Neuroblastoma often begins in the nerve tissue of the adrenal glands. There are two adrenal glands, one on top of each kidney in the back of the upper abdomen. The adrenal glands make important hormones that help control heart rate, blood pressure, blood sugar, and the way the body reacts to stress. Neuroblastoma may also begin in the abdomen, in the chest, in nerve tissue near the spine in the neck, or in the spinal cord.

Anatomy of the female urinary system; drawing shows a front view of the right and left kidneys, the ureters,  urethra, and bladder filled with urine. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine. The spine, adrenal glands, and uterus are also shown.

Anatomy of the female urinary system showing the kidneys, adrenal glands, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.

Neuroblastoma most often begins during early childhood, usually in children younger than 5 years of age. It is found when the tumour begins to grow and cause symptoms. Sometimes it forms before birth and is found during a fetal ultrasound.

By the time neuroblastoma is diagnosed, the cancer has usually metastasized (spread). Neuroblastoma spreads most often to the lymph nodes, bones, bone marrow, liver, and in infants, skin.


Ganglioneuroblastoma is an intermediate tumour that arises from nerve tissues. An intermediate tumour is one that is between benign (slow-growing and unlikely to spread) and malignant (fast-growing, aggressive, and likely to spread).

This is a very rare tumour that occurs in children. tumours of the nervous system have different degrees of differentiation. The degree of differentiation is based on how the tumour cells look under the microscope. It can predict whether or not they are likely to spread. Benign tumours are less likely to spread. Malignant tumours are aggressive, grow quickly, and often spread. A ganglioneuroma is a benign tumour. A neuroblastoma (occurring in children over 1 year old) is usually malignant.

A ganglioneuroblastoma may be only in one area or it may be widespread, but it is usually less aggressive than a neuroblastoma.

The cause is unknown.


Most commonly, a lump can be felt in the abdomen.

Exams and Tests

The health care provider may do the following tests:

  • Bone marrow aspiration and biopsy
  • Bone scan
  • CT scan or MRI scan of the affected area
  • Metaiodobenzylguanidine (MIBG) scan
  • Special blood and urine tests
  • Surgical biopsy to confirm diagnosis


Depending on the type of tumour, treatment can involve surgery, and possibly chemotherapy and radiation therapy.
Because these tumours are rare, they should be treated in a specialized center by experts who have experience with them.

Outlook (Prognosis)

The outlook depends on how far the tumour has spread, and whether some areas of the tumour contain more aggressive cancer cells.

Possible Complications

Complications that may result include:

  • Complications of surgery, radiation, or chemotherapy
  • Spread of the tumour into surrounding areas

Neuroblastoma is sometimes caused by a gene mutation (change) passed from the parent to the child.

Neuroblastoma is sometimes inherited (passed from the parent to the child). Neuroblastoma that is inherited usually occurs at a younger age than neuroblastoma that is not inherited. In inherited neuroblastoma, more than one tumour may form in the adrenal medulla.

Possible signs and symptoms of neuroblastoma include bone pain and a lump in the abdomen, neck, or chest.

The most common signs and symptoms of neuroblastoma are caused by the tumour pressing on nearby tissues as it grows or by cancer spreading to the bone. These and other signs and symptoms may be caused by neuroblastoma or by other conditions.

Check with your child’s doctor if your child has any of the following:

  • Lump in the abdomen, neck, or chest.
  • Bulging eyes.
  • Dark circles around the eyes ("black eyes").
  • Bone pain.
  • Swollen stomach and trouble breathing (in infants).
  • Painless, bluish lumps under the skin (in infants).
  • Weakness or paralysis (loss of ability to move a body part).

Less common signs and symptoms of neuroblastoma include the following:

  • Fever.
  • Shortness of breath.
  • Feeling tired.
  • Easy bruising or bleeding.
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding).
  • High blood pressure.
  • Severe watery diarrhea.
  • Jerky muscle movements.
  • Uncontrolled eye movement.

Tests that examine many different body tissues and fluids are used to detect (find) and diagnose neuroblastoma.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
  • Urine catecholamine studies: A procedure in which a urine sample is checked to measure the amount of certain substances, vanillylmandelic acid (VMA) and homovanillic acid (HVA), that are made when catecholamines break down and are released into the urine. A higher than normal amount of VMA or HVA can be a sign of neuroblastoma.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. A higher than normal amount ofthe hormones dopamine and norepinephrine may be a sign of neuroblastoma.
  • MIBG (metaiodobenzylguanidine) scan: A procedure used to find neuroendocrine tumours, such as neuroblastoma and pheochromocytoma. A very small amount of a substance called radioactive mIBG is injected into a vein and travels through the bloodstream. Neuroendocrine tumour cells take up the radioactive mIBG and are detected by a scanner. Scans may be taken over 1-3 days. An iodine solution may be given before or during the test to keep the thyroid gland from absorbing too much of the mIBG. This test is also used to find out how well the tumour is responding to treatment. mIBG is used in high doses to treat neuroblastoma.
  • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
  • X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

A biopsy is done to diagnose neuroblastoma.

Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. The way the biopsy is done depends on where the tumour is in the body. Sometimes the whole tumour is removed at the same time the biopsy is done.

The following tests may be done on the tissue that is removed:

  • Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
  • Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
  • Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
  • MYC-N amplification study: A laboratory study in which tumour or bone marrow cells are checked for the level of MYC-N. MYC-N is important for cell growth. A higher levelof MYC-N (more than 10 copies of the gene) is called MYC-N amplification. Neuroblastoma with MYC-N amplification is more likely to spread in the body and less likely to respond to treatment.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • Age of the child at diagnosis.
  • Stage of the cancer.
  • tumour histology (the shape, function, and structure of the tumour cells).
  • Whether there is cancer in the lymph nodes on the same side of the body as the cancer or whether there is cancer in the lymph nodes on the opposite side of the body.
  • How the tumour responds to treatment.
  • Whether there are certain changes in the chromosomes.
  • How much time passed between diagnosis and when the cancer recurred (for recurrent cancer).

Prognosis and treatment options for neuroblastoma are also affected by tumour biology, which includes:

  • The patterns of the tumour cells.
  • How different the tumour cells are from normal cells.
  • How fast the tumour cells are growing.
  • Whether the tumour shows MYC-N amplification.

The tumour biology is said to be favorable or unfavorable, depending on these factors. A favorable tumour biology means there is a better chance of recovery.

In some infants, neuroblastoma may disappear without treatment. The infant is closely watched for symptoms of neuroblastoma. If symptoms occur, treatment may be needed.

For more information on Neuroblastoma click here

This link is to the National Cancer Institute (NCI) cancer website in the United States. There may be references to drugs and clinical trials that are not available here in Australia.