Diagnosis

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When your child is diagnosed with cancer, it can feel overwhelming. This phase involves finding out if your child has cancer, and determining the type of cancer they have. Children’s cancer can be difficult to diagnose, as many symptoms are similar to those caused by less serious conditions, or injuries. This means that your child may need several tests and medical appointments before you receive confirmation that your child has cancer.

If your doctor thinks your child has neuroblastoma, they may undergo the following tests:

  • medical history and physical exam
  • blood tests
  • urine tests
  • medical imaging, such as:
    • X-ray
    • ultrasound
    • computed tomography (CT) scan
    • magnetic resonance imaging (MRI)
    • bone scan
    • metaiodobenzylguanidine (MIBG) scan
    • positron emission tomography (PET) scan
  • biopsy, perhaps with a test for genetic changes to help find the best way to treat your child
  • bone marrow aspiration and biopsy, done from two separate places in the body at the same time (bilateral). Your child may have more than one of these tests.

Our section, How is cancer diagnosed? explains these tests in more detail.

The tests can:

  • diagnose neuroblastoma
  • determine the tumour’s size and exact location
  • show if it has spread to other parts of the body.

Staging

Doctors use staging to describe how much the cancer has grown. Some of the tests for neuroblastoma will also help to stage the tumour. Staging measures:

  • where the tumour is
  • how big the tumour is
  • what nearby organs it affects
  • if the cancer has spread to other parts of the body.

Your doctor will use this information to determine the best way to treat the disease. Staging will also give your doctor an idea of how well these treatments are likely to work (prognosis).

How doctors stage neuroblastoma varies. The following four stages are part of the International Neuroblastoma Staging System (INSS), which is used after surgery:1

  • Stage 1 – the tumour is in one part of the body. Surgery removes all parts of the tumour that the doctors can see.
  • Stage 2A – the tumour is in one part of the body. Doctors have not removed all parts of the tumour that they can see during surgery.
  • Stage 2B – the tumour is in one part of the body. Doctors have removed all parts of the tumour that they can see during surgery. However, neuroblastoma cells occur in nearby lymph nodes.
  • Stage 3 - involves one of the following
    • Doctors have not completely removed the tumour by surgery. The cancer has spread to the other side of the body or to nearby lymph nodes.
    • The tumour is on one 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 doctors cannot completely remove it by surgery. It has spread to tissues or lymph nodes on both sides of the body.
  • Stage 4 – the tumour has spread to other parts of the body, such as
    • distant lymph nodes
    • liver
    • bones 
    • bone marrow
    • the skin.
  • Stage 4S (also called special neuroblastoma) – the child is less than one year old. The tumour is only in one part of the body, and doctors have removed all parts of the tumour that they can find during the surgery. However, the cancer has spread to
    • the liver
    • skin 
    • bone marrow.

Doctors may also use the INRGSS, which uses symptoms and medical imaging to determine the stage before any surgery.2

Stage L1 – Locoregional tumour without image-defined risk factors

  • the tumour is only in one part of the body and there are no organs close to it that are at risk of being damaged by the tumour

Stage L2 – Locoregional tumour with one or more image-defined risk factors

  • the tumour is only in one part of the body but is pressing on or wrapping around organs nearby

Stage M – Distant metastatic disease (except Ms)

  • the tumour has spread to other parts of the body (bones, bone marrow, distant lymph nodes, liver)

Stage Ms – Stage L1/2 tumour with metastatic disease confined to skin and/or liver and/or bone marrow

  • this is a specific subtype of neuroblastoma where the tumour has spread only to the skin, liver and/or bone marrow (less than 10% involvement) in patients younger than 18 months of age.


References

[1] https://www.cancer.net/cancer-types/neuroblastoma-childhood/stages-and-groups

[2] The International Neuroblastoma Risk Group (INRG) staging system: An INRG task force report