Neuroblastoma Diagnosis and Stages
UT Southwestern Medical Center partners with Children’s Health to diagnose and treat pediatric cancers such as neuroblastoma. Because neuroblastoma is rare – even though it’s the most common cancer in children under age 1, it accounts for just with 700-800 new cases diagnosed in the United States each year – it’s important for patients to receive an evaluation of symptoms from skilled pediatric oncologists.
UT Southwestern treats a large number of neuroblastoma patients, and that gives our physicians the experience and expertise to provide the best care.
Our pediatric cancer specialists use the most advanced diagnostic tools to identify neuroblastoma.
Our physicians begin with a thorough evaluation that includes a:
- Discussion of symptoms
- Review of personal and family medical history
- Physical and neurological exam
We may order additional tests, such as:
- Blood and urine tests: These measure hormone levels and substances that could indicate cancer.
- Biopsy: The doctor removes a sample of tissue to be examined in a laboratory for cancer.
- Bone marrow sampling: This test, which involves the doctor using a specialized needle to remove a small sample of bone marrow from inside one of the bones, confirms whether the neuroblastoma has spread there.
- Imaging exams: These include MIBG scans, ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
Stages of Neuroblastoma
Staging is a way to measure the spread and size of the cancer. This helps our doctors create a treatment plan that’s personalized to each patient.
There are two recognized staging systems for neuroblastoma:
- International Neuroblastoma Risk Group Staging System (INRGSS): Uses results from imaging exams to determine the cancer’s stage
- International Neuroblastoma Staging System (INSS): Uses surgical results of the tumor removal to determine the cancer’s stage
INRGSS was developed to determine how aggressive the neuroblastoma is before treatment starts.
- L1: The tumor is located in one area of the body, such as the chest, neck, or abdomen.
- L2: The tumor has spread to a nearby area and is showing at least one image-defined risk factor.
- M: The tumor has spread to a distant part of the body (does not include stage MS).
- MS: In patients younger than 18 months, this refers to patients whose cancer has spread to the liver, skin, and/or bone marrow (with no more than 10 percent bone marrow involvement).
- Stage 1: The cancer is located where it started, and all of the visible tumor can be removed completely by surgery.
- Stage 2: Divided into two stages:
- 2A: The tumor is located where it started, but it could not be completely removed by surgery.
- 2B: The tumor is on one side of the body, and it may or may not be able to be removed completely by surgery.
- Stage 3: The cancer may or may not be able to be removed completely by surgery, and it may be in nearby lymph nodes. It has not spread to distant parts of the body.
- Stage 4: The cancer has spread to distant parts of the body (does not include stage 4S).
- Stage 4S: In children younger than age 1, this refers to cancer that has spread to the skin, liver, and/or bone marrow (with no more than 10 percent bone marrow involvement).