Neuroblastoma: symptoms, stages and treatments

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

One such type occurs in neuroblasts, immature cells of the nervous system. We are talking about neuroblastoma, a rare cancer It generally appears in the child population, being one of the most common in infants and children under four years of age (in fact, it is the most frequent before two years of age).

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Neuroblastoma: definition and symptoms

The term neuroblastoma refers to a rare type of cancer, but nevertheless it is the most frequent in childhood before two years of age. It is a type of embryonal tumor in which there is an accelerated, uncontrolled and infiltrative growth of the precursor cells of neurons and glia: neuroblasts.

These cells are formed during the gestation of the individual, appearing and forming part of the neural plate for later develop and differentiate during fetal development to form the cells of our nervous system (both neurons and neuroglia). In other words,

are the precursors of our nerve cells.

Although most neuroblasts become nerve cells during development fetal, occasionally some children can maintain even after birth some of them, immature They usually go away over time, but sometimes for some reason They can grow uncontrollably and become a tumor.

They generally appear in the ganglia or in the nerve bundles of the autonomic nervous system, although this may mean that they can practically appear anywhere in the body. The areas in which it most commonly appears are in the adrenal glands (being its most common point of origin), abdomen, marrow or thorax.

symptomatology

One of the difficulties of this disease is that the symptoms it can cause are initially very not very specific, making it easy to confuse it with other alterations or even pass unnoticed. In fact, in many cases they are only seen when the tumor has already grown, so it is relatively frequent. that it is only detected once it has even metastasized.

Most often, appetite disturbances, fatigue, and weakness appear. There is also usually fever, pain and gastric disorders. Other symptoms will depend to a large extent on the area where the tumor appears. For example headaches, dizziness or vision problems are common if there is brain involvement, bruising in the eyes or the existence of inequality between the two pupils in terms of size. In addition, problems appear when urinating, moving, maintaining balance, as well as tachycardia, bone and/or abdominal pain, or respiratory problems are also common.

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The stages of neuroblastoma

As in other cancers, in neuroblastoma the existence of a series of phases can be observed and stages in which the tumor can be located according to its degree of malignancy, location and infiltration in other tissues. In this sense we can find:

• Stage 1: The tumor is localized and well demarcated. Its surgical removal can be simple
• Stage 2: The tumor is localized but nearby lymph nodes are seen to have cancer cells. removal is complicated.
• Stage 3: In this stage the tumor is advanced and large and cannot be resected or resection would not kill all the cancer cells
• Stage 4: Stage 4 indicates that the tumor has advanced and has infiltrated different tissues, metastasizing. Despite this, in some cases of children under 1 year of age (which we would call stage 4S) the subject can recover despite said metastasis.

What are your causes?

The causes of the appearance of a neuroblastoma are currently unknown, although it is proposed the existence of genetic problems that may cause this problem to arise. In fact, in some cases there is a family history, so that there could be talk of some transmissibility in some cases (although it is not something in the majority).

Treatment

Treating a neuroblastoma successfully depends on the presence of certain variables, such as the location of the tumor, the stage in which it is found and its level of spread, the age of the minor or the resistance to previous treatments.

In some cases it is possible that no treatment is required, since it has been observed that sometimes the tumor disappears on its own or transforms into a benign tumor. As regards the rest of the cases, it may be enough to remove the tumor, but chemotherapy and/or radiation therapy may also be required (especially in those cases where there is some dissemination) to cure the disease or reduce its rate of growth.

In cases where intensive chemotherapy is carried out, which stops cell growth, it is common for prior to This means that the patient's own stem cells are collected for their subsequent reintroduction into the body once the treatment has been completed. chemotherapy. You can also have a bone marrow transplant of the minor himself (removing it before the application of the treatment). On those occasions in which the tumor is resected, immunotherapy can subsequently be carried out by injecting antibodies that allow the patient's own immune system to fight and destroy cell debris tumors.

But regardless of how effective a treatment may or may not be, it must be borne in mind that it is a type of tumor that especially affects young children, with which it must be done taking into account what the fact of undergoing certain treatments may entail for a minor. Surgical interventions, 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 for the minor and generate great fear and anxiety.

It is necessary to try to make the minor's experience as less traumatic and aversive as possible. For this, different techniques can be applied, such as the Lazarus emotional staging technique, making for example the child can visualize himself as a superhero with whom he identifies and who through the treatment is fighting evil.

Psychoeducation of parents is also important, since it allows them to raise the issue, clear up and express doubts and feelings, learn strategies to try to handle the situation and in turn contributing to the fact that the emotional reactions of the parents do not generate negative anticipations and a higher level of fear and anguish in the child. minor. It would also be useful to go to support or mutual help groups, in order to learn about other cases and share experiences with subjects who have suffered the same problem.

Forecast

The prognosis of each case can vary greatly depending on various variables. For example, it is possible that in some cases the tumor can become a benign tumor or even disappear on its own, especially when it occurs in very young children.

However, in many other cases, if it is not treated or is detected late, metastasis may occur. In fact, in the vast majority of cases, the diagnosis is made when this has already occurred.

Treatment is generally effective in non-disseminated tumors, although when there is already metastasis, treatment is usually much more complex. One thing to keep in mind is that the younger the child, the less likely it is that there may be recurrences in the future.

Regarding survival, generally in patients with low risk (stages 1 and 2) the prognosis is very positive after treatment, with a 95% survival rate. Those with intermediate or moderate risk (2-3) also have a very high survival rate (more than 80%). However, unfortunately in patients with high risk (with dissemination, with stage 4 tumor) the survival rate is reduced to 50%.

Bibliographic references:

• Dome, J.S., Rodriguez-Galindo, C., Spunt, S.L., Santana, V.M. (2014). Pediatric solid tumors. In: Niederhuber, J.E., Armitage, J.O., Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; chap 95
• Maris, J.M. (2010). Recent Advances in Neuroblastoma. no. engl. J. Med., 362: 2202-2211.
• Modak, S, Cheung, N.K. (2010) Neuroblastoma: Therapeutic strategies for a clinical enigma. Cancer Treat Rev.,36(4):307-317.