Rare Cancers In Childhood - Neuroblastoma

Rare cancer in childhood
Cancer in childhood are rare, approximately 1 in every 600 children will develop any type of cancer before the age of 15 due to abnormal cells growth in part of a child body.

Neuroblastoma,
An extracranial solid cancer arises from nerve tissue found in infants and children as a result of untrollable cells growth caused by genetic mutation. It is classified into 3 risk categories: low, intermediate, and high risk. The disease occurs in 1 out of 100,000 children.

Symptoms
1. Fever
Abnormally consistent fever symptoms may be a symptoms of neuroblastoma, it happens to about approximately 25 percent of patients.

2. Pain
Complained about constant abdomen pain may also be a symptom of neuroblastoma as over 65% neuroblastoma center at the abdomen.
3. Loss of appetite
A general symptom of any form of cancer
4. Weight loss
Any unintentional weight loss over 10% is a sign of cancer.
5. Bone pain or tenderness
if the cancer has spreads to the bone
6. Difficulty breathing or a chronic cough
if the cancer has spread to the lung
7. Enlarged abdomen
As a result from a large tumor or excess fluid accumulation.
8. Pale skin
Cancer has interfered with production of red blood cells
9. Paralysis of the hips, legs, or feet
It may be caused the enlarge tumor has interfered with nerve function in controlling the movement of lower extremities
10. Loss of body balance
May be due to the cancer has interfered with function of vestibulocochlear nerve
11. Uncontrolled eye movements
AS cancer has interfered with one or all cranial nerves
12.Etc.

Causes and risk factors
1. Gene
Neuroblastoma arises from nerve tissue found in infants and children, as a result of uncontrollable cells growth caused by genetic mutation. Children with below genetic disorders are at risk of the cancer
a. Neurofibromatosis
Neurofibromatosis is a genetically-inherited disorder of nerve tissue grows benign tumors.
b. Fetal hydantoin syndrome
Fetal Hydantoin Syndrome is a rare disorder caused by exposure of a fetus to the anticonvulsant drug phenytoin (Dilantin).
c. Beckwith-Wiedemann Syndrome
Beckwith–Wiedemann syndrome (BWS) is an overgrowth disorder affecting many parts of the body an unusual rate.
d. Etc.
4. Family history
Risk of the cancer increases if you have a family history of the cancer.
5. Age
Children below 15 years of age are at increased risk of neuroblastoma
6. Heredity
The cancer may be genetic passing through from your parent affecting approximately 2% of all cases.
7. Etc.

Diagnosis and tests
After recording the family history and physical exam, including lumps, sweeling, and any other signs of the disease
1. 24 hours urine tests
If you doctor suspected that it may be Neuroblastoma, the first tesrt will be 24 hours urine test for level of the markers - homovanillic acid (HMA) and vanillyl mandelic acid (VMA). A sign of Neuroblastoma if higher than normal amount of homovanillic acid (HMA) and vanillyl mandelic acid (VMA) is found.

2. Blood chemistry test
A sign of neuroblastoma if the blood chemitry test came back with elevation of markers of hormones dopamine and norepinephrine.

3. CT Scan (computerized tomography)
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes.

4. Ultrasound
Ultrasound allows your doctor to visualize and assess the size and to check for any abnormality and surrounding area with image taken from the test.

5. Biopsy
A sample of the effected area is taken by a thin tube-like instrument, under local anesthesia or general anesthesia examined by a pathologist under microscopy to view the type and stage of the cancer.

6. Chest X ray
Check X ray is to check the lung for spreading of the cancer.

7. Etc.

Grades
The Grades of Neuroblastoma are depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Stages
Neuroblastoma is classified as 5 stages
1. Stage 0
If the cancerous cell have not penetrated in deeper tissue but in the surface of the nerve tissue.

2. Stage I
In stage I, the cancerous cells are no longer in the surface but have invaded into deep the prostate lining, but still completely inside the nerve tissue.
a. Stage IA
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1:
The invasion area is ≥ 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2:
The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b. Stage IB:
The cancer in this stage have invaded the connective tissue but less than 5cm (2 inch)
b.1. Stage IB1:
Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:
Cancer is ≥ 4 cm (1 3/4 inches) but less than 5cm (2 inch)

3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the nerve tissue.

4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the nerve tissue.

5. Stage IV
In this stage, cancerous cells has spread to the tissues immediately outside of the affected nerve tissue into other distant parts of the body.

Treatments
Treatment depends to the location, grade and stage of the cancer.
1. Surgery
a. The aim of the surgery is to cure, if the cancer has not spread and the location is fieasible for operation. your surgeon will remove as much of the tumor as possible. If cancer can not remove completely then radiotherapy to kill cells locally or chemotherapy to kill the remaining cancerous cells in the body.
b. Risks and Side effects
Surgical and anesthesia risk

2. Radiotherapy
a. Sometime doctors give radiation for kidney tumors after surgery and before chemotherapy. Radiation may be used to kill any cancer cells remaining in the body locally. By using high-energy x-rays or other types of radiation, radiation therapy kills the cancer cells and keep them from growing or regrowing.
b. Side effects
b.1. Fatigue
b.2. Chest pain
b.3. Heart problem
b.4. Short of breath
b.5. Skin discoloration or pinkness, irritation.
b.6. Etc.

3. Chemotherapy
a. If the cancer has spread, chemotherapy with use of drugs very effectively to cure neuroblastoma, even the cancer has spread to distant part of the body.

Chemotherapy is mostly used to treat with advance stage of cancer combined with radio therapy. Chemo is recommended to shrink the tumor if surgery is not possible. In some cases, high doses of chemotherapy may be recommended.

b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

4. Monoclonal antibody therapy
a. Monoclonal antibody therapy is the use of antibodies attach to the substances by killing the cancer cells, keeping them from spreading given by infusion.
b. Most common risks and side effects
b.1. Heart problem and low blood pressure
b.2. Skin rashes, itching and infection
b.3. Fever and muscle pain
b.4. Fatigue, tiredness and headache
b.5. Diarrhea
b.6. Nausea and vomiting
b.7. Etc.

5. Stem cell transplant
a. In Neuroblastoma, stem cells of a donor or are removed from the blood or bone marrow of the patient are frozen and stored. After other treatments are completed, the stored cells are infused back to the body.
b. Risks and side effects
b.1. Bone marrow suppression
b.2. Infection
b.3. Graft-Versus-Host Disease
b.a. Graft Failure
b.5. Cancer Relapse
b.6. Etc.
6. Etc.
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