Does your little one have Neuroblastoma cancer? Don't worry, let's talk about this simply!

Does your little one have a lump on their stomach or neck that feels like a lump? Or are there bruises or blue spots around their eyes that look like they've been hit? Every mother or father is very scared and worried when they see something like this. It's very common. But sometimes these can be symptoms of a type of cancer called 'Neuroblastoma', which occurs especially in young children. So today, let's talk about this without fear and clearly explain everything you need to know.

What exactly is Neuroblastoma?

Simply put, Neuroblastoma is a type of cancer that develops in the nervous system of young children and infants. Our body's nerves are formed from immature nerve cells called 'neuroblasts'. Neuroblastoma cancer develops in these immature nerve cells.

Most often, this cancer starts in immature nerve cells in the adrenal glands, two small glands located above the kidneys. These glands produce hormones that control many things in our body that we don't even realize happen, such as heart rate, blood pressure, breathing, and digestion. In addition to this, this cancer can also start in nerve tissue in the spine, stomach, chest, or neck. Over time, these cancer cells can spread to other parts of the body.

The prognosis for a child with this disease depends on several factors, including the location of the cancer, the child's age, and the stage (how far the cancer has spread).

Is this a very common disease?

No, Neuroblastoma is a relatively rare cancer. But the most important thing is that it is the most common type of cancer seen in infants. This disease usually occurs in children under the age of 5. Sometimes this cancer can develop even while a child is still in the womb. It is very rare to see this cancer in children over the age of 10.

How are the stages of Neuroblastoma classified?

If your child is confirmed to have this disease, the doctors will next look at how far the cancer has spread and how fast it is growing. This will determine the 'risk level' of the disease. Only then will the most suitable treatment option for the child be chosen.

In the past, this stage was determined by looking at how much cancer was left in the body after surgery. But now, doctors use an internationally accepted method. In it, the stage is determined by looking at how far the cancer has spread, based on scans (such as a `CT scan` or `MRI`). Let's understand these stages in simple terms.

Why does this kind of cancer develop?

The main reason for this is that the immature nerve cells (`neuroblasts`) we talked about earlier grow uncontrollably. When a genetic mutation occurs in those cells, those cells begin to divide and grow abnormally. The cells that accumulate in this way form a tumor. Doctors still do not know the exact cause of this genetic mutation.

However, if someone in the family has had Neuroblastoma before, there is a small chance that the child will develop it. But it is very rare. Also, children born with other congenital anomalies are at slightly higher risk of developing this disease.

What are the symptoms of this disease?

The symptoms of neuroblastoma vary widely. Some may start very slowly. These symptoms depend on the location of the tumor and the stage of the disease. Often, by the time symptoms appear, the cancer has already spread to other parts of the body.

Here are some common symptoms:

• Lumps: A lump that is palpable in the neck, chest, abdomen, or pelvis. In infants, several blue or purple lumps may be seen under the skin.
• Eyes: Eyes that appear to be protruding forward, with a black/blue color around the eyes, as if bruised.
• Stomach discomfort: Diarrhea, constipation, stomach pain, loss of appetite.
• Fatigue and paleness: Constant fatigue, cough, fever. Pale skin. This is due to anemia, which is a decrease in red blood cells.
• Bloating: The stomach is swollen and painful.
• Difficulty breathing: Especially in young babies.
• Weakness: Weakness in the legs and feet, difficulty walking, or paralysis.

As the disease progresses, symptoms such as these may also appear:

• High blood pressure and rapid heartbeat.
• Pain in the bones, back, or legs.
• Problems with body balance and movement.
• Rapid, uncontrolled eye movements.
• A condition called Horner's syndrome, which is characterized by drooping eyelids on only one side of the face, small pupils, and decreased sweating.

How do doctors diagnose this disease?

This condition is often diagnosed in children under the age of 5. Sometimes, this lump can be seen even during an ultrasound scan while the baby is still in the womb.

Your doctor will perform several tests to confirm the diagnosis.

Physical Examination

First, the doctor will examine the child carefully. They will check for lumps and other abnormalities. They will also perform a neurological exam to check the functioning of the nervous system, reflexes, and coordination.

Blood and Urine Tests

These tests include a complete blood count (CBC) to check for anemia and other blood abnormalities, and checking levels of certain chemicals that accumulate in the blood and urine when cancer is present.

Biopsy

What is done here is to take a very small piece of tissue from the lump and examine it under a microscope. This is what makes it 100% certain that it is Neuroblastoma. It also checks whether the cancer cells in this piece of tissue have any special changes in their chromosomes. That information is very important in determining the child's risk level and treatment plan.

Bone Marrow Biopsy

Bone marrow is the spongy part inside our large bones. This is where our blood cells are made. This test is done to see if cancer has spread to the bone marrow.

Imaging Scans

Several types of scans are done to see where the cancer is, how big it is, and whether it has spread to other areas.

• CT scan: A special dye is injected into the body and a series of X-ray images are taken.
• MRI scan: Uses magnets and radio waves to take detailed pictures of the inside of the body.
• MIBG scan: This is a scan that is specific to Neuroblastoma. In this scan, a safe radioactive chemical is injected into the body. This chemical goes to the areas where the Neuroblastoma cells are located. Then, when viewed with a special camera, it is possible to clearly see where the cancer has spread in the body. However, about 10% of children's cancer cells do not absorb this MIBG. In such cases, another type of scan called a `PET scan` is used.
• Ultrasound scan and X-ray: These are primarily used to get a rough idea of ​​the location of the tumor and its effect on surrounding organs.

What are the treatments for Neuroblastoma?

Treatment is determined by the child's age, stage of the disease, risk level, and location of the tumor. A team of doctors will work with you to develop the best treatment plan for your child.

Treatment according to risk level

• Low-Risk Neuroblastoma: Some children in this category, especially those under 6 months of age, may be kept under observation by their doctor without any treatment. This is because some tumors go away on their own without any treatment. Other children may need surgery, chemotherapy, or both to remove the tumor.
• Intermediate-Risk Neuroblastoma: These children usually have surgery to remove the tumor. If it has spread to the lymph nodes, they are also removed. Chemotherapy is given after surgery. Sometimes, chemotherapy may be given before surgery to shrink the tumor.
• High-Risk Neuroblastoma: These children are given a combination of treatments. This may include chemotherapy, surgery, high-dose chemotherapy with stem cell transplant, radiation, and immunotherapy.

Let's learn a little more about the treatment methods.

It is very important that you have a clear understanding of what treatments are being given to your child and what they will entail.

What is the chance of curing this disease? (Prognosis)

This is the biggest question on every parent's mind. The recovery rate for children with neuroblastoma varies.

• The recovery rate is very high for children in the low or medium risk category , especially young children. About 90% - 95% of children recover completely.
• The recovery rate for older children in the high-risk group is about 60% .

But don't give up hope. Doctors and researchers are constantly trying to find more effective treatments for this high-risk group of children. There are many new treatments that have already shown successful results.

Can this disease be prevented?

Unfortunately, there is no way to prevent Neuroblastoma. If you or your partner had this disease as a child, or if someone in your family has a history of it, talk to your doctor about it. But remember, hereditary Neuroblastoma is very, very rare (only 1% - 2%).

When should I see a doctor?

If you suspect that your child has any of the symptoms we've discussed, don't delay and see a doctor as soon as possible. In such cases, early diagnosis and treatment can greatly affect the child's recovery.

When a child is diagnosed with cancer, it can be hard for the whole family to cope. It's a big shock. But you're not alone. The doctors, nurses, and staff who treat these children are very dedicated. Also, ask your doctor about support groups where you can talk to other parents who have had similar experiences. Sharing experiences and hearing others' stories can be a great source of strength for you.

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