Neuroblastoma: Treatment, Procedure, Cost and Side Effects

Neuroblastoma is also known as metastatic tumor, malignant neoplasm and malignant tumor.

Neuroblastoma is a type of cancer that is commonly found in the adrenal glands of people. It occurs when malignant or cancerous cells form in the neuroblasts (immature nerve tissue) in the adrenal gland, neck, chest, or spinal cord. Gene mutation or change from parent to child may cause neuroblastoma.

Signs and symptoms of neuroblastoma noted in patients which help in the detection of this disease are caused by the tumor as it grows and thus presses on nearby tissues or even by cancer cells which mutate and spread to the bones. The common signs and symptoms of neuroblastoma are lump in the abdomen, neck, or chest, protruding or bulging eyes, dark circles around the eyes (also known as "black eyes"), bone pain etc. In infants, the stomach become swollen and they have trouble in breathing. Weakness and fatigue with painless bluish lumps under the skin are also noted. Apart from these, the less common yet notable symptoms are fever, high blood pressure, diarrhoea, etc.

Treatment methods of neuroblastoma depend on various factors. The size and location of tumor, side effects and other risks along with the patient’s overall health condition are looked into prior to beginning the operation. The treatment options are surgery, chemotherapy, intake of drugs (oral and intravenous), radiation therapy, bone marrow transplant, retinoid therapy, immunotherapy etc.

By the time neuroblastoma is diagnosed, the malignant cells may have spread to a greater extent. The diagnostic tests done to determine this condition include a huge range of examinations and lab studies. An overall health study with the patient’s medical history is done. Neuro exam or a neurologic exam helps the doctor learn about the patient’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. Urine samples are also collected to measure the amount of certain substances present in it. The urine catecholamine studies help to detect vanillylmandelic acid (VMA) and homovanillic acid (HVA), which are found to be present in the urine in huge amount when there are symptoms of neuroblastoma. CT scan, X rays and blood chemical studies are also performed. Magnetic resonance imaging with a substance called gadolinium can zoom into the cancer cells and magnify the images for better detection. MIBG (metaiodobenzylguanidine) scan is a type of procedure that can detect neuroblastoma. Many times ultrasound and biopsy are also performed for better diagnosis and determination of treatment method.

Treatment of neuroblastoma depends on several factors like the patient’s age, medical conditions and history, size location and severity of the tumor or cancer cells. There are several treatment methods. Surgery involves the removal of the tumor and some surrounding healthy tissues to prevent any risk of leaving behind cancer cells during an operation. If the tumor cannot be removed completely, patients are given biopsy surgery or chemotherapy and radiation therapy. Chemotherapy uses various drugs to kill the cancer cells, thus, inhibiting its growth and subsequent spreading. Chemotherapy has a period of time in which it is repeated and it is commonly applied as an intravenous (IV) medicine into a vein or muscle using a needle or in a pill or capsule that is taken orally. Chemotherapy is in fact the primary treatment for neuroblastoma. Carboplatin(Paraplatin), Cyclophosphamide(Neosar), Busulfan(Busulfex, Myleran), Dinutuximab (Unituxin), Melphalan (Alkeran) and others are commonly used drugs for patients. Radiation therapy uses high-energy x-rays or other particles to destroy cancer cells. Retinoid therapy is another method where substances similar to vitamin A are used for treatment. When chemotherapy does not work for some tumor cells, 13-cis-retinoic acid (RA) or isotretinoin is given to children or patients with high-risk neuroblastoma. In order to prevent further complications of the condition, immunotherapy is done. This helps to boost the body’s natural defences to fight the cancer.

It is hard to detect neuroblastoma. By the time it is detected, major parts of the cancer cells have already spread. Thus, as soon as the detection of neuroblastoma is made, patients should undergo the treatment and medical care. The early the treatment begins, the better. Any people, including children, when show symptoms that can be aligned to those of neuroblastoma must be taken for medical assistance.

People with normal and healthy living conditions and no signs and symptoms of neuroblastoma or cancer/ tumor do not need to undergo treatment. Also, some patients have other medical conditions or health issues because of which they are not able to take chemotherapy or radiation therapy. Thus, these people are not eligible for treatment.

There are a number of side effects of the treatmenrt methods used in the cure of neuroblastoma. These side effects are mostly noted in children and they seem to have a long term effect which show up towards the late stages of life. One major adverse effect even after treatment could be the recurrence of the disease in the patient. Otherwise, side effects associated with treatment methods are usually cardio vascular problems, hearing, kidney problems, hormonal changes etc. There are also chances of getting other types of cancers. These include breast cancer, skin cancer etc. Chemotherapy can cause several side effects on the patients. Starting from hair loss to depression and deterioration of health, all these are caused due to chemotherapy and radiation therapy. Some times people fail to cope up with the treatment methods and degenerate.

In case of chemotherapy and radiation therapy, treatment takes a long time and happens in periods. Thus, these patients must stay away from the sun and other sources of heat to prevent reaction in the body. They should maintain care and hygiene and also be strictly protected from other sources that could cause a problem. Taking oral medicines properly, visiting the doctor as and when required, checking the blood and urine contents monthly and noting the overall health condition of the patient are some of the post treatment guidelines.

Time for recovery and prognosis depends on several factors. The stage of the cancer and the time of the treatment control recovery. Patients with stage 4 and stage 5 neuroblastoma or cancer rarely show any signs of improvement and recovery. People detected with early stages of cancer can still fight it. Recovery time is long and vary from individuals depending on their conditions. Some people take a year or two to recover while some are not able to recover. The symptoms are brought under control and life span can be increased a bit, but full chances of recovery are pretty low in case of neuroblastoma.

Treatment of cancer cells is a cost indulging one. The treatment expenses are huge as these treatments are done in a periodic way for a noted period of time. Higher the stages and associated risks of cancer, greater the treatment dosages. Thus, it is always involving a huge amount of money. Chemotherapy, radiation therapy, biopsy, stem cell transplant etc. incur costs around Rs 1500000- Rs 3000000/-. Sometimes the treatment costs are even greater due to the tests and additional medicines required.

Treatment can be permanent if the cancer cells or tumor is detected early. But, particularly in the case of neuroblastoma, by the time it is detected, cancer cells mutate and spread. Even then, proper treatment methods can alleviate the issue to some extent. But, many times, cancer cells are found to recur in the patients in a severe form than former. Treatment vaguely brings in positive outcome for patients in the last stages of cancer.