Neuroblastoma: symptoms, stages and treatments

This type of Cancer arises from neuroblasts, nerve cells in their early stage.

For many years, "cancer" has been a frightening word for most people. It refers to one of the diseases that continue to pose a great challenge to medicine to this day. There are many types of tumor that can appear in our organism, being possible that they can be generated in any type of tissue and at any age.

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

Neuroblastoma: definition and symptoms

The term neuroblastoma refers to a rare type of cancer, but nevertheless the most common cancer in childhood before the age of two years. before the age of two years. 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: the neuroblasts.

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

Although most neuroblasts are transformed into nerve cells during fetal development, occasionally some children may keep some of them immature even after birth. They usually disappear with time, but sometimes for some reason they can grow out of control and become a tumor. they can grow in an uncontrolled manner and become a tumor..

They generally appear in the ganglia or in the nerve bundles of the autonomic nervous system, although this may imply that they can appear almost anywhere in the body. The areas where they most commonly appear are in the adrenal glands (being their most common point of origin), abdomen, medulla or thorax.

Symptomatology

One of the difficulties of this disease is that the symptoms that may arise are initially very unspecific, making it easy to confuse it with other disorders or even go unnoticed. In fact, in many cases they are only observed when the tumor has already grown, so that it is relatively frequent that they are only detected once the tumor has grown. only detected once it has even metastasized..

Most frequently, appetite alterations, fatigue and weakness appear. There is also usually fever, pain and gastric alterations. Other symptoms will depend to a great extent on the area in which the tumor appears. For example, headaches, dizziness headaches, dizziness or vision problems are common. if there is cerebral affectation, hematomas in the eyes or the existence of inequality between both pupils as far as size is concerned. In addition, problems appear when urinating, moving, maintaining balance, as well as tachycardia, bone and/or abdominal pain or respiratory problems are also common.

Stages of neuroblastoma

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

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

What are the causes?

The causes of the appearance of neuroblastoma are currently unknown, although the following are proposed the existence of genetic problems that can generate the emergence of this problem. In fact, in some cases there are family antecedents, so that it is possible to speak of a certain transmissibility in some cases (although it is not the majority).

Treatment

Successful treatment of 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 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. In other cases, removal of the tumor may be sufficient, but chemotherapy and/or radiation may also be required. chemotherapy and/or radiotherapy may also be required (especially in those cases where there is (especially in those cases in which there is some dissemination) to cure the disease or reduce its rate of growth.

In cases where chemotherapy is carried out in an intensive manner, which stops cell growth, it is common for the patient's own stem cells to be harvested beforehand for later reintroduction into the body once the chemotherapy is completed. A transplant can also be made from the child's own bone marrow (by extracting it from the bone marrow). of the child himself (extracted before the application of the treatment). On those occasions when the tumor is resected, immunotherapy can be carried out later by injecting antibodies that allow the patient's own immune system to fight and destroy the remains of tumor cells.

But regardless of how effective a treatment may or may not be, it must be borne in mind that this is a type of tumor that especially affects young children. especially affects young childrenThis must be done taking into account what it can mean for a minor to undergo certain treatments. Surgical interventions, relatively frequent visits to the doctor, check-ups, injections, the use of therapies such as radiotherapy or chemotherapy or possible hospital stays can be extremely aversive for the child and generate great fear and anxiety.

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

Psychoeducation of the parents is also important.It allows them to raise the issue, clear and express doubts and feelings, learn strategies to try to manage the situation and at the same time contribute to the parents' emotional reactions not generating negative anticipations and a higher level of fear and anguish in the child. It would also be useful to attend support groups or mutual help groups, in order to learn about other cases and share experiences with subjects who have suffered the same problem.

Prognosis

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

However, in many other cases, if left untreated or detected late, metastasis may occur. In fact, in the vast majority of cases the diagnosis is made when this has already occurred.

The treatment is usually effective in non disseminated tumors, although when metastasis is already present the treatment is usually much more complex. One aspect to bear in mind is that the younger the child, the less likely it is that there will be recurrences in the future..

As far as survival is concerned, generally in patients at 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, being the tumor stage 4) 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. N. 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.