Relapsed or Refractory Neuroblastoma | Symptoms & Causes
What are the symptoms of relapsed neuroblastoma?
As with newly diagnosed neuroblastoma, the symptoms of relapsed neuroblastoma can vary greatly, depending on the size and location of the tumor and whether or not the tumor has spread.
While neuroblastoma usually begins in the abdomen, especially in the tissues of the adrenal glands, it may also begin in nerve tissues in the neck, chest or pelvis. These tumors often spread to other areas of the body, including the lymph nodes, liver, bones and bone marrow.
The symptoms of relapsed neuroblastoma can include:
- an abdominal mass
- enlarged lymph nodes in the neck
- swelling and bruising of the area around the eyes
- unexplained fevers, bone pain or limping
- weakness or paralysis
- weight loss or poor appetite
- uncontrolled eye or leg movements
What causes relapsed neuroblastoma in children?
It is important to understand that tumors often emerge with no known cause. Many may result from the combined effects of genetic and environmental factors, but some cancers are caused by inherited conditions. Conditions associated with pheochromocytomas include neurofibromatosis, von Hippel-Lindau disease, multiple endocrine neoplasia (MEN) syndromes, tuberous sclerosis, Sturge-Weber syndrome, and ataxia-telangiectasia.
Adrenocortical carcinomas are often linked to genetic conditions, most often Li-Fraumeni syndrome. About 50 to 80 percent of pediatric ACC patients have this syndrome. Other related conditions include MEN1, Lynch syndrome, Beckwith-Wiedemann syndrome, and hemihypertrophy.
Relapsed or Refractory Neuroblastoma | Diagnosis & Treatments
How is relapsed neuroblastoma diagnosed?
To make a diagnosis of relapsed neuroblastoma, your doctor may order a variety of tests, including:
- computerized tomography (CT or CAT) scan
- magnetic resonance imaging (MRI) scan
- bone scan
- metaiodobenzylguanidine (MIBG) scan
- bone marrow biopsy and/or aspiration
- urine tests
- blood tests
In some cases, your doctor may also order a tumor biopsy, in which surgeons or interventional radiologists remove either a piece of the tumor or the whole tumor, depending on tumor location and size. Pediatric pathologists will analyze the tumor, and other important tests will be done to determine the tumor biology, such as genetic studies to look for genes that may be targeted using new drugs.
After all tests are completed, doctors will be able to outline the best treatment options.
What are the treatment options for relapsed and refractory neuroblastoma?
There is no standard treatment for relapsed neuroblastoma. Rather, our treatment approach is personalized for each patient depending on several factors, including:
- extent of relapse
- length of time from prior treatment
- type of prior treatment
Treatment options for relapsed neuroblastoma include MIBG therapy, which uses a radioactive isotope that is readily absorbed by most neuroblastomas and can be used to detect neuroblastoma in the body or to deliver radiation in order to kill the neuroblastoma cells. It may also include chemotherapy using combinations of chemotherapy agents not used to treat newly diagnosed neuroblastoma, or immunotherapy generally given in combination with chemotherapy.
We also offer innovative clinical trials of experimental agents (Phase 1 or 2) for children with relapsed or recurrent neuroblastoma.