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Neuroblastoma

Last reviewed: 14 Dec 2024
Last updated: 30 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age <5 years
  • abdominal distention
  • abdominal mass
  • pain
  • decreased appetite
  • weight loss
  • fussiness (infants)
  • fatigue
  • periorbital ecchymosis (panda eyes)
  • subcutaneous skin nodules
  • signs of spinal cord compression
  • signs of Horner's syndrome
  • signs of superior vena cava syndrome
  • intractable secretory diarrhoea
  • opsoclonus-myoclonus ataxia (OMA)
Full details

Other diagnostic factors

  • constipation
  • pallor
  • bleeding
  • infections
  • hypertension
  • hepatomegaly
Full details

Risk factors

  • neurocristopathies or other syndromes
  • family history of neuroblastic tumours or genetic predisposition
Full details

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • serum creatinine/urea
  • liver function tests (LFTs)
  • serum lactate dehydrogenase (LDH)
  • urine catecholamines
  • ultrasound abdomen
  • CT scan
  • MRI scan
Full details

Investigations to consider

  • tumour biopsy
  • bilateral bone marrow aspiration and biopsy
  • serum vasoactive intestinal peptide (VIP)
  • 123-iodine-metaiodobenzylguanidine (MIBG) scintigraphy
  • positron emission tomography with 18-F-deoxyglucose (18F-FDG PET)
  • radionuclide bone scan
Full details

Treatment algorithm

ACUTE

low-risk disease

intermediate-risk disease

high-risk disease

ONGOING

relapsed or refractory disease

Contributors

Authors

Jason Shohet, MD, PhD

Associate Professor

Co-chairman

Neuroblastoma Research Program

Texas Children's Cancer Center and Center for Cell and Gene Therapy

Baylor College of Medicine Houston

TX

Disclosures

JS declares that he has no competing interests.

Jennifer Foster, MD, MPH

Clinical Director

Neuroblastoma Program

Assistant Professor

Department of Pediatrics Section of Hematology/Oncology

Texas Children's Cancer Center

Baylor College of Medicine

Houston

TX

Disclosures

JF has served on the advisory board for Y-mAbs.

Peer reviewers

Juliet C Gray, MB, BS, MA, MRCPCH, PhD

Associate Professor and Consultant in Paediatric Oncology

University of Southampton

Southampton

UK

Disclosures

JCG declares that she has no competing interests.

Daniel Weiser, MD

Medical Director, Intra-Abdominal Solid Tumor Program

Children's Hospital at Montefiore

Assistant Professor, Departments of Pediatrics & Genetics

Albert Einstein College of Medicine

Bronx

NY

Disclosures

DW declares that he has no competing interests.

David Ziegler, MBBS, BSc (Med), FRACP, MD/PhD

Senior Staff Specialist

Sydney Children’s Hospital

Randwick

Sydney

Australia

Disclosures

DZ declares that he has no competing interests.

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