Your child will have a number of tests to investigate their symptoms and confirm a diagnosis of neuroblastoma, including:
- medical history and physical examination
- blood tests
- urine tests
- medical imaging, which may include:
- computed tomography (CT) scan
- magnetic resonance imaging (MRI)
- bone scan
- metaidobenzylguanidine (MIBG) scan
- positron emission tomography (PET) scan
- biopsy – where a small sample of the cancer is removed to be examined under a microscope. The sample can also be tested for genetic changes that can help determine the best type of treatment for your child
- bone marrow aspiration and biopsy – where a sample of bone marrow is taken with a small piece of bone to be examined under a microscope. This is done from 2 separate places in the body at the same time (called a bilateral bone marrow aspiration). Your child will probably have more than one of these tests.
These tests are explained in more detail in How is cancer diagnosed?.
The tests are designed to diagnose neuroblastoma, as well as determine the size of the tumour, its exact location in the body and whether it has spread to other parts of the body. The most common places it spreads to are the lymph nodes, liver, bones and bone marrow, and sometimes the skin.
If your child is diagnosed with neuroblastoma, some of the diagnostic tests will also help to stage the tumour. Staging determines where the tumour is, how big it is, which nearby organs are involved and whether the cancer has spread to other parts of the body. This is important to determine the outlook (prognosis) for your child, and to decide on the best options for treatment.
There are different ways of staging neuroblastoma – the following is the most commonly used:
The tumour is only in 1 part of the body, and all of the tumour that can be seen has been removed by surgery.
Stage 2 includes stages 2A and 2B:
- Stage 2A – the tumour is only in 1 part of the body, but not all of the tumour that can be seen has been removed by surgery
- Stage 2B – the tumour is only in 1 part of the body, and all of the tumour that can be seen has been removed by surgery. However, there are neuroblastoma cells in nearby lymph nodes.
Stage 3 involves 1 of the following:
- The tumour has not been completely removed by surgery and has spread to the other side of the body or to nearby lymph nodes
- The tumour is on 1 side of the body but has spread to lymph nodes on the other side of the body
- The tumour is in the middle of the body and cannot be completely removed by surgery. It has spread to tissues or lymph nodes on both sides of the body.
Stage 4 includes stages 4 and 4S:
- Stage 4 – the tumour has spread to other parts of the body such as distant lymph nodes, liver, bones or bone marrow, or the skin
- Stage 4S (also called special neuroblastoma) – the child is less than 1 year old. The tumour is only in 1 part of the body, and all the tumour that can be seen may be removed by surgery. However, the cancer has spread to the liver, skin or bone marrow, and maybe the lymph nodes near the tumour.