What're treatments for neuroblastoma?
Once neuroblastoma has been diagnosed, the physician will perform more tests to determine if the cancer has spread to other tissues in the body. This process, called staging, is important for the physician to determine how to treat the cancer
and check liver and kidney function. The staging system for neuroblastoma is based on how far the disease has spread from its original site to other tissues in the body.
Localized resectable (able to be cut out) neuroblastoma is confined to the site of origin, with no evidence that it has spread to other tissues, and the cancer can be surgically removed. Localized unresectable neuroblastoma is confined to the site of origin, but the cancer cannot be completely removed surgically. Regional neuroblastoma has extended beyond its original site, to regional lymph nodes, and/or surrounding organs or tissues, but has not spread to distant sites in the body. Disseminated neuroblastoma has spread to distant lymph nodes, bone, liver, skin, bone marrow, and/or other organs. Stage 4S (or IVS, or "special") neuroblastoma has spread only to liver, skin, and/or, to a very limited extent, bone marrow. Recurrent neuroblastoma means that the cancer has come back, or continued to spread after it has been treated. It may come back in the original site or in another part of the body.
The prognosis for all children with neuroblastoma improves with early treatment. Localized tumors, which are those that have not spread, can be surgically removed, either completely or incompletely. Nonsurgical treatments include radiation and chemotherapy. Radiation therapy uses very strong x-rays to kill the cancer cells. Radiation can make your child feel extremely tired and may cause nausea and vomiting. Chemotherapy involves doses of very strong medicines to kill the cancer cells. Chemotherapy also has side effects, including hair loss, nausea, vomiting, and extreme tiredness. These side effects are temporary and will go away once the radiation and chemotherapy treatments are finished. Your doctor can prescribe medicine to counteract these side effects if your child cannot tolerate them. Chemotherapy may also be used before surgery to shrink the tumor so it is easier to remove. In addition to destroying the cancer cells, radiation and chemotherapy can kill bone marrow cells. For this reason, the child's healthy bone marrow can be removed before treatment, and then replaced later. Diseased or destroyed bone marrow can also be replaced with healthy bone marrow from a donor, usually a family member. Children under the age of one and those with small tumors have the best survival rate.
Surgery is used whenever possible, to remove as much of the cancer as possible, and can generally cure the disease if the cancer has not spread to other areas of the body. Before surgery, chemotherapy may be used to shrink the tumor so that it can be more easily removed during surgery; this is called neoadjuvant chemotherapy. Radiation therapy is often used after surgery; high-energy rays (radiation) are used to kill as many of the remaining cancer cells as possible. Chemotherapy (called adjuvant chemotherapy) may also be used after surgery to kill remaining cells. Bone marrow transplantation is used to replace bone marrow cells killed by radiation or chemotherapy. In some cases the patient's own bone marrow is removed prior to treatment and saved for transplantation later. Other times the bone marrow comes from a "matched" donor, such as a sibling.