Neuroblastoma: symptoms, stages and treatments

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

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

    Neuroblastoma: definition and symptoms

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

    These cells form during an individual’s pregnancy, appear and are part of the neural plate to develop and differentiate later in fetal development to form the cells of our nervous system (the two neurons with neuroglia). In other words, they are the precursors of our nerve cells.

    While most neuroblasts are transformed into nerve cells during fetal development, some children can sometimes keep some of them immature even after birth. They usually go away over time, but sometimes for some reason they can grow out of control and become a tumor.

    They usually appear in ganglia or nerve bundles of the autonomic nervous system, although this could mean they can appear virtually anywhere in the body. The areas where it appears most often are the adrenal glands (being its most common point of origin), the abdomen, the spinal cord or the chest.

    symptomatology

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

    The most common are changes in appetite, fatigue and weakness. There is also usually fever, pain, and stomach upset. Other symptoms largely depend on the area in which the tumor appears. for example headaches, dizziness, or vision problems are common if there is brain damage, bruising of the eyes, or the existence of an inequality between the two pupils in terms of height. In addition, problems appear with urination, movement, maintaining balance, as well as tachycardia, bone and / or abdominal pain or breathing problems are also common.

      The stages of neuroblastoma

      As in other cancers, in neuroblastoma you can see the existence of a series of phases and stages in which the tumor can be located depending on its degree of malignancy, location and infiltration in other fabrics. In this sense, we can find:

      • Step 1: The tumor is localized and very delineated. Its surgical removal can be simple
      • Stage 2: The tumor is localized but it is observed that the neighboring lymph nodes contain cancer cells. Withdrawal is complicated.
      • Stage 3: At this point, the tumor is advanced and large and cannot be resected or this resection would not remove all cancer cells.
      • Stage 4: Stage 4 indicates that the tumor has advanced and it infiltrated different tissues, metastasizing. However, in some cases of children under one year of age (which we would call stage 4S), the subject may recover despite this metastasis.

      What are its causes?

      The causes of a neuroblastoma are currently unknown, although it is proposed the existence of genetic problems which can lead to the emergence of this problem. In fact, in some cases there is a family history, so one could speak of some transmissibility in some cases (although it is not a majority thing).

      treatment

      The success of treating a neuroblastoma depends on the presence of certain variables, such as the location of the tumor, its stage and level of spread, the age of the child or the resistance to previous treatments.

      In some cases, treatment may not be necessary, as it has been observed that the tumor sometimes goes away on its own or turns into a benign tumor. As in the rest of the cases, removal of the tumor may be sufficient, however they may also require chemotherapy and / or radiation therapy (Especially in cases where there is some spread) to cure the disease or slow down its rate of growth.

      In cases where the chemotherapy is carried out intensively, which stops cell growth, it is common for the patient’s own stem cells to be collected before that for later reintroduction into the body after the chemotherapy is completed. A bone marrow transplant can also be done of the minor himself (extraction before application of the treatment). In cases where the tumor is resected, then immunotherapy can be performed by injecting antibodies that allow the patient’s immune system to fight and destroy the remnants of tumor cells.

      But regardless of how well a treatment works or not, keep in mind that this is a type of tumor that particularly affects young childrenIt must therefore be done taking into account what it may mean for a child to undergo certain treatments. Surgery, 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 to the child and cause great fear and great anxiety.

      We must try to make the child’s experience as traumatic and aversive as possible. To do this, they can apply different techniques such as the Lazarus Emotional Staging Technique, for example allowing the child to visualize himself as a superhero with whom he identifies and who, through treatment, fight evil.

      Parental psychoeducation is also important, As this allows them to raise the issue, clarify and express doubts and feelings, learn strategies to try to deal with the situation and in turn contribute to the fact that the emotional reactions of parents do not generate in turn negative anticipations and a higher level of fear and anxiety in the minor. It would also be useful to go to support or self-help groups, in order to know about other cases and to share experiences with subjects who have suffered from the same problem.

      Provide

      The prognosis of each case can vary considerably depending on several variables. For example, in some cases the tumor may turn into a benign tumor or even go away on its own, especially when given to very young children.

      However, in many cases, metastases may not occur if left untreated or detected late. In fact, in the vast majority of cases, the diagnosis is made when it has already happened.

      Treatment is usually only effective in nondisseminated tumors, although when there is already metastasis to treatment, it is usually much more complex. One aspect to keep in mind is that the younger the child, the lower the likelihood of recurrence in the future.

      In terms of survival, generally among low-risk patients (stages 1 and 2), the prognosis is very positive after treatment, with a survival rate of 95%. Those at intermediate or moderate risk (2-3) also have a very high survival rate (over 80%). However, unfortunately in high risk patients (if there is spread, the tumor is in stage 4) the survival rate is reduced. up to 50%.

      Bibliographical references:

      • Dome, JS, Rodriguez-Galindo, C., Spunt, SL, Santana, VM (2014). Pediatric solid tumors. A: Niederhuber, JE, Armitage, JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff clinical oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; chap 95.
      • Maris, JM (2010). Recent advances in neuroblastoma. N. English. 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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