Neuroblastoma, which constitutes an important part of the tumors seen in childhood, usually occurs by chance, but can be life-threatening if left untreated.
Early diagnosis is of great importance in neuroblastoma, which can be seen in a routine ultrasound examination or with careful monitoring of the mother. Therefore, children and babies should be examined routinely. Professor of Pediatric Surgery Department of Memorial Şişli / Bahçelievler Hospital. Dr. Nüvit Sarımurat gave information about neuroblastoma and its treatment.
Neuroblastoma is the second most common solid tumor after childhood brain tumors and constitutes 7-8 percent of such cancers seen in childhood. It is seen more frequently in boys than girls. Children with this condition are diagnosed around the age of 1-2 on average. It is rare after 10 years of age. The reason for the occurrence of neuroblastoma is not yet clear. It is described as a tumor that originates from the primitive cells of the "sympathetic nervous system", which are believed down from either side of the spine. In addition, it is known that it can originate from the adrenal gland, or adrenal gland, which is a neuroendocrine gland. It is possible to see this tumor in areas called the chest cavity, abdominal cavity or pelvis. It is mostly found in the abdomen in the body.
It can show itself with swelling in the abdomen
It is usually noticed during routine ultrasound examinations or when mothers see a swelling in their abdomen while loving their children. In addition, a hard swelling in the neck of the child, loss of appetite, bone pain in case of spreading to distant tissues, swelling of the legs, constipation or diarrhea; In the chest, symptoms such as chest pain and respiratory distress can be seen. This tumor can also be considered in unexplained fever, weight loss, back and bone pain. In particular, metastases in long bones such as arms and legs or around the eyes and skull can cause bone pain. If there is a common involvement in the bone marrow; Anemia, decrease in platelets and decrease in white blood cells, associated infections or tendency to bleeding may occur. On physical examination, the mass in the abdomen, the location and size of this mass, whether the liver size is large, and the presence of lymph nodes should be carefully examined.
Modern examinations help diagnosis
Once the tumor is recognized, the family should be referred to a pediatric oncologist. The pediatric oncologist ensures that tests related to the tumor are performed at this stage. Differential diagnosis is very important here. Complete blood count, MRI, ultrasound and CT may be required. In addition, it is checked whether the tumor has chemical residues. Substances such as Vanilla Mandelic Acid, VMA and Neuron Specific Enolase (NSE), are required in differential diagnosis.
Staging is important for treatment
Staging of the tumor is done with these diagnostic procedures. The stages of neuroblastoma can be listed as follows:
- Stage 1: The tumor is limited in the organ it originates from, it does not cross the midline.
- Stage 2: The tumor is involved in the lymph nodes on the side, but it does not pass the midline.
- Stage 3: There is a tumor that crosses the midline, lymph nodes are involved on the opposite side of the midline.
- Stage 4: Common disease, metastases to distant organs can be seen.
- Stage 4S: At this stage, the patient is less than 1 year old, but there is spread to the liver, skin and bone marrow.
The course of treatment is related to staging and the nature of the tumor. Some tumors are more aggressive and some are slower.
Surgically removed if the tumor is limited
Surgical methods in pediatric cancers are generally removing the tumor if the tumor is confined to the organ it originates from. However, if the tumor is too large to be removed or if it has spread to other tissues, then a biopsy is taken from the tumor and the tumor and / or metastases are tried to be destroyed by applying chemotherapy. After the tumor shrinks and metastases disappear, the tumor residue is surgically removed.
According to the type of treatment planned to be performed, other additional examinations are performed to check the status and functions of some organs before the treatment begins. These tests can be listed as heart examination, hearing control and kidney function tests before chemotherapy. In addition, various examinations should be made regarding the growth status of the child, which has an important place in treatment.