Pediatric Cancer Care

Pediatrics

Cancer Care

Research-based care for a nervous system cancer in young children

Neuroblastoma

Personalized Treatment for Your Child

Neuroblastoma is a cancer of the peripheral nervous system which is made up of the spinal cord and the nerves that branch off of it. It is one of the most common childhood cancers and the most common cancer in infants. Nearly half of patients are under age 2. Thanks to new treatments developed through research, the survival rate of children with neuroblastoma has dramatically risen. When the disease has not spread, it can be cured, and more than half of patients with metastatic neuroblastoma can survive their illness.

At NewYork-Presbyterian, we perform genetic analysis of each patient's tumor to match them with the most effective neuroblastoma treatments, offering surgery, chemotherapy, immunotherapy, and radiation therapy. Our goal is to achieve a cure with as few short-term and long-term side effects as possible.

Signs and symptoms of neuroblastoma

Neuroblastoma tumors can form anywhere along the sympathetic nervous system, which runs from the neck to the pelvis. They most often develop in the adrenal glands, located above the kidneys. The symptoms of neuroblastoma may also be caused by other illnesses. If your child has any of these symptoms and they are not caused by something else, are not going away, or are getting worse, see your pediatrician:

  • Swelling in the belly
  • Fevers
  • Loss of weight or less desire to eat
  • Achiness and pains
  • Walking with a limp or other difficulties

Neuroblastoma diagnosis 

Your care team will perform exams and tests to determine the cause of your child's symptoms. All tests are done with your child's comfort in mind and may include:

  • Physical exam
  • Urine tests, which may show high levels of hormones called catecholamines and the metabolites they break down into: dopamine, homovanillic acid (HVA), and/or vanillylmandelic acid (VMA)
  • Imaging exams such as CT and MRI scanning
  • MIBG scan, which shows a radioactive substance binding to neuroblastoma cells if they are present
  • Biopsy of tumor tissue to see if it is cancer
  • Bone marrow analysis in some cases to see if neuroblastoma has spread to the bones

Stages of neuroblastoma

When neuroblastoma is diagnosed, doctors look further to see how much it has grown and whether it has spread — a process called staging. They also assign a risk group that represents its likelihood of coming back after treatment. Each neuroblastoma risk group is treated differently. Neuroblastoma is classified as:

  • Low-risk neuroblastoma. This type of cancer is most commonly found in infants and children who have very small operable tumors.
  • Intermediate-risk neuroblastoma. This group includes patients under 18 months of age with tumors that have spread and children with larger neuroblastomas that have not spread.
  • High-risk neuroblastoma. This category is for children over 18 months old whose neuroblastoma has spread. Patients whose tumors contain a genetic alteration called MYCN amplification are also classified as high risk.

Our approach to care

Pediatrics-Cancer Care-Neuroblastoma.jpgOur pediatric oncologists, surgeons, and oncology nurses have the expertise and compassion to treat children with neuroblastoma. They work with social workers, child life specialists, art therapists, registered dietitians, integrative health professionals, and others to ensure that your child's experience is as comfortable as possible. If your child needs care from a doctor in another field, we offer that, too, with every type of pediatric specialist available at NewYork-Presbyterian.

How we treat neuroblastoma

Your child's treatment is customized to the stage of their disease and risk of recurrence. 

Observation. Your child may not need any treatment at all if the doctor believes the neuroblastoma is low risk and can be just watched to make sure it is not getting worse. Neuroblastoma can change on its own from a malignant cancer to a benign tumor in some patients.

Surgery. Some children with low-risk neuroblastoma only need surgery. Others may have surgery combined with other treatments. Our pediatric surgeons operate with precision and skill. 

Chemotherapy. Treatment with anticancer drugs is common in children with intermediate-risk and high-risk neuroblastoma. They may receive chemotherapy before surgery to shrink the tumor and after surgery to kill any cancer cells remaining in the body. 

Antibody therapy. There are certain immunotherapies designed just for patients with neuroblastoma — especially those whose cancer persists despite other treatments. The U.S. Food and Drug Administration approved the antibody naxitamab (Hu3F8) to treat children with persistent high-risk neuroblastoma. Other antibodies for neuroblastoma are available through participation in clinical trials. 

Radiation therapy. There are different types of radiation therapy used in the treatment of neuroblastoma, including standard external beam radiation therapy and proton therapy. The latter is a preferred option to treat children because the proton radiation beams only penetrate the body to a certain depth and then stop, reducing radiation damage to nearby healthy tissues. In addition, MIBG is a form of "liquid radiation therapy" used to reach neuroblastoma cells throughout the body. Radiation therapy care is offered by professionals at both Columbia and Weill Cornell Medicine. 

Investigational treatments. Research is continuing to develop even better therapies for neuroblastoma. Your child may have opportunities to participate in clinical trials of innovative treatments, conducted by Columbia University and Weill Cornell Medicine investigators. These studies are especially hopeful for families of patients whose tumors are still growing and no longer responding to other treatments.

Why choose us

Neuroblastoma is a complex cancer to treat, but also one of the evolving success stories in pediatric cancer care. With new therapies arriving in the clinic and others under evaluation in clinical trials, there is reason for optimism. At NewYork-Presbyterian, our neuroblastoma care is based on the findings of the latest medical research, customized to the genetic features of your child's cancer. Call us today to make an appointment.

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