How Neuroblastoma Is Diagnosed

Neuroblastoma is a cancer that develops in immature nerve cells. It usually affects children under 5 years of age. Neuroblastoma can develop in the adrenal glands (by the kidneys), back, chest, and neck.

Your child’s doctor may use physical exams, lab work, and imaging to diagnose neuroblastoma. Here’s an overview of what to expect.

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Home checks

Home checkups for neuroblastoma are not intended to help you diagnose your child. Instead, they are intended to increase awareness of the possible symptoms. Home checkups can help detect cancer early rather than after it has progressed.

Gently feel around your child’s spine, neck, chest and abdomen for lumps. If you feel a mass, keep in mind that it could be related to another condition, such as an infection. You want to have it looked at by your child’s doctor.

Signs and Symptoms

Other signs and symptoms of neuroblastoma include:

Tiredness or feeling tired Bruising easily Chronic diarrhea Back, chest, neck or abdominal pain

Physical examination

At an appointment with your child’s doctor, they will ask you questions about your child’s symptoms, such as when they started. They will also review your child’s medical history and may also ask you questions about your family’s medical history.

The next step is for your child’s doctor to perform a physical exam, listening to your child’s breathing and heartbeat, as well as feeling for any lumps or masses.

A physical exam will help your child’s doctor narrow down the possible causes of your child’s symptoms. While an exam is sometimes enough to diagnose certain conditions, a condition such as cancer usually requires additional testing to make a diagnosis.

Labs and Tests

Blood tests help your child’s doctor assess how well your child’s body is doing by looking at markers of their nutritional status, immune system, and organ function.

Complete blood count (CBC): A CBC test is one of the most common blood tests doctors order. It gives them information such as the number of red blood cells and white blood cells, as well as the levels of hemoglobin and other markers.
Basic Metabolic Panel (BMP): A BMP is often done to see how well a person’s metabolism is working. Calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium and blood urea nitrogen (BUN) are all included in the BMP.
biopsy: A biopsy is a tissue sample that is collected and tested in a lab to look for abnormal cells. For neuroblastoma, a biopsy of the mass itself may be taken to confirm the diagnosis. It can also help doctors develop a treatment plan. A health care provider may also take a bone marrow sample, as this is one of the most common places for neuroblastoma to spread.

Imaging

If your child has a lump under the skin, a doctor can assess it to some extent by feeling it. They may also want to do imaging tests that help them see better, or look at other parts of the body to see if there are masses elsewhere that can’t be felt.

X-ray: X-rays produce an image of the body in various shades of black, white and gray. With neuroblastoma, X-rays can be used to assess bone health and see if cancer has spread to the bones.
ultrasound: An ultrasound sends sound waves through the body, and the echoes can help assess various organs and structures. If your doctor suspects a tumor, an ultrasound may be one of the first imaging tests used, as they are easily performed in young children. The test works best for seeing tumors in the abdomen.
Computed Tomography (CT) Scan: CT scans combine multiple X-rays to create a detailed image of the inside of the body. The test is often used to assess neuroblastoma tumors in the pelvis, chest, or abdomen.
Magnetic Resonance Imaging (MRI): An MRI provides detailed images of the body’s soft tissues, making it the preferred way to look for neuroblastoma tumors. This type of imaging helps doctors see the details and size of tumors clearly, and can help them plan to remove the masses through surgery.
Metaiodobenzylguanidine (MIBG) scan: An MIBG scan is often done after neuroblastoma has been confirmed with other imaging. MIBG helps assess whether cancer has spread to other parts of the body. MIBG contains a small amount of radioactive iodine that is taken up by the tumor cells. When the scan is complete, the cells that ingested the MIBG will appear on the image. While the test is effective in about 90% to 95% of people with neuroblastoma, a small percentage of people have tumors that resist taking up MIBG.
Positron Emission Tomography (PET) Scan: PET scans use radioactive substances to create images of tumors. The substance is given in a low dose and is not harmful, it disappears from the body within a few days. The test may not complete if an MIBG scan is done, but it can be helpful if someone has tumors that don’t absorb MIBG.

Differential diagnoses

Many of the signs and symptoms of neuroblastoma can occur in other diseases as well. Conditions your child’s doctor will want to rule out before diagnosing neuroblastoma include:

dermoid cyst: A benign lump under the skin
Infection: An infection can cause a lump and some of the other symptoms seen in neuroblastoma
Ewing’s sarcoma: A type of cancer that often develops in or around bones
germ cell tumor: A type of cancer that forms around the reproductive organs
Hepatoblastoma: A rare childhood cancer that develops in the liver
Infantile fibromatosis: A rare type of benign tumor that can grow in skin, muscle or bone cells
lymphoma: A type of cancer that affects the lymphatic system (part of the immune system)
Rhabdomyosarcoma: A type of soft tissue cancer that usually begins in muscle tissue attached to bones
Small round cell sarcoma: A type of soft tissue cancer
Wilms syndrome: A rare form of childhood cancer that starts in the kidneys

Resume

If your child has any signs or symptoms of neuroblastoma, let the doctor know. Their doctor can do an exam, conduct medical tests, and talk to you about your family history to find out if your child’s symptoms are caused by cancer or something else.

A word from Verywell

A cancer diagnosis is a life-changing event, but know that treatment options are available for neuroblastoma and research is underway to treat this type of cancer. If your child has been diagnosed with neuroblastoma, their healthcare team will discuss all treatment options with you and guide your family through the process.

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