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DIAGNOSIS


Signs and symptoms

The first symptoms are often vague, such as loss of appetite and tiredness.
Other symptoms vary depending on where the neuroblastoma starts. If the
tumour is in the abdomen, the child’s tummy may be swollen and the child
may complain of constipation or have difficulty passing urine.
If the tumour affects the chest area, the child may be breathless and have difficulty in swallowing. Less often, children may have weakness in the legs
and walk unsteadily if the tumour is pressing on the spinal cord.



How it is diagnosed

A variety of tests and investigations may be needed to diagnose a neuroblastoma. Tests such as x-rays, CT or MRI scans, bone-marrow tests
and blood tests are carried out to find the exact position of the
neuroblastoma within the body and whether it has spread. This is known as staging (see below).

A specific type of urine test will also be done. Nearly all children with neuroblastoma will have substances called vanyllylmandelic acid (VMA), or
homovanillic acid (HVA), in their urine. Measuring the VMA and HVA in the
urine can help to confirm the diagnosis. Your child will also have their VMA
and HVA levels checked during treatment. The levels of these substances
will fall if the treatment is working. As these chemicals are produced by the
tumour cells, and can be used to measure tumour activity, they are
sometimes known as tumour markers.

An MIBG (meta-iodo-benzyl guanidine) scan may also be done. MIBG is a
substance that is taken up by neuroblastoma cells. It is given by injection.
Attaching a small amount of radioactive iodine to the MIBG enables the
tumours to be seen by a radiation scanner. MIBG may also be used as a treatment. A biopsy of the tumour is usually taken. This involves removing
a small sample of cells during an operation under a general anaesthetic.
The cells are then examined under a microscope.



Staging

The 'stage' of a cancer is a term used to describe its size and whether it
has spread beyond its original site. Knowing the particular type and the
stage of the cancer helps the doctors to decide on the most appropriate treatment.

A commonly used staging system for neuroblastoma is described below:

Stage 1 The cancer is contained within one area of the body (localised)
and there is no evidence of spread. It can be completely removed by
surgery or there may be very small (microscopic) amounts of tumour left.

Stage 2A The cancer is localised and has not begun to spread, but
cannot be completely removed by surgery.

Stage 2B The cancer is localised and has begun to spread into nearby
lymph nodes.

Stage 3 The cancer has spread into surrounding organs and structures,
but has not spread to distant areas of the body.

Stage 4 The cancer has spread to distant lymph nodes, bone, bone
marrow, liver, skin or other organs.

Stage 4S The cancer is localised (as in stage 1, 2A or 2B) and has begun
to spread to the liver, skin or to some extent the bone marrow. This is
found in children under a year old.

If the cancer has spread to distant parts of the body this is known as
secondary cancer (or metastatic cancer).

If the cancer comes back after initial treatment it is known as recurrent
cancer.