Neuroblastoma

Most children with neuroblastoma receive a diagnosis before age 5. In fact, neuroblastoma is the most common cancer in infants. Sometimes, providers diagnose neuroblastoma in a developing fetus during a prenatal ultrasound.

To diagnose neuroblastoma, your child’s provider will do a physical and neurological examination. A neurological exam checks your child’s nerve function, reflexes and coordination. Your child’s provider may order several tests to confirm a diagnosis and see if the cancer has spread. These tests include:

• Blood and urine tests: To check for anemia and abnormalities in the blood, your child’s provider will order a complete blood count (CBC). Blood chemistry tests measure hormone levels and detect substances in the blood that may be a sign of cancer. A urine test measures the levels of chemicals in your child’s body.
• Biopsy: During a biopsy, your child’s provider removes a tissue sample and sends it to a laboratory. The laboratory will look at the tumor tissue under a microscope, and perform various tests on the biopsy sample to confirm the diagnosis of neuroblastoma. Specialized tests of the biopsy sample will check for specific chromosomal alterations of the tumor cells themselves – this can help determine your child’s risk category and treatment plan.
• Bone marrow biopsy: A bone marrow biopsy tests bone, bone marrow and blood for signs of cancer. Bone marrow is the sponge-like tissue at the center of large bones. Blood cells form in bone marrow.
• CT scan: During a CT scan, your provider injects a special dye into your child’s vein and then performs a series of X-rays. The dye makes it easier for the provider to see tissues and tumors.
• MRI scan: An MRI scan uses a magnet and radio waves to produce images of soft tissues.
• Methyliodobenzylguanine (MIBG) scan: This imaging test uses a safe radioactive chemical called 123-iodinated MIBG radiotracer. Your child’s provider injects radiotracer into a vein, and the next day, uses a special type of scanner to take pictures of your child’s organs. The 123-iodinated MIBG compound is very specific for neuroblastoma cells, so the radiotracer will go to any areas of the body where neuroblastoma is located. This specialized nuclear medicine scan helps your doctor determine whether or not the neuroblastoma has spread to other areas of the body. However, about 10% of patients will have neuroblastoma tumors that do not take up the MIBG compound. In this situation, another type of nuclear medicine scan called a PET scan can be done to find all areas of active neuroblastoma cells in the body.
• Ultrasound: An ultrasound test uses high-frequency sound waves to create images of soft tissues.
• X-ray: A chest X-ray or abdominal X-ray can help your child’s provider see the location of the tumor and how it’s affecting other tissues in the body. An X-ray is an easy screening test to determine a less detailed picture of how the cancer is affecting the body.