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Tests and diagnosis
By Mayo Clinic staffTests and procedures used to diagnose neuroblastoma include:
- Physical exam. Your child's doctor conducts a physical exam to check out any signs and symptoms. The doctor will ask you questions about your child's habits and behaviors.
- Urine and blood tests in children. These may indicate the cause of any signs and symptoms your child is experiencing. Urine tests may be used to check for high levels of certain chemicals that result from the neuroblastoma cells producing excess catecholamines.
- Imaging tests. Imaging tests may reveal a mass that may indicate a tumor. Imaging tests may include X-ray, ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI), among others.
- Tumor biopsy. If a mass is found, your child's doctor may want to remove a sample of the tissue for laboratory testing (biopsy). An incisional biopsy is a surgical procedure to remove a small piece of tissue from the tumor. If the cancer is small and confined to one area, the surgeon may remove the entire tumor and send it to a laboratory for examination (excisional biopsy). Specialized tests can reveal what types of cells are involved in the tumor and specific genetic characteristics of the cancer cells. This information helps your child's doctor devise an individualized treatment plan.
- Bone marrow biopsy. Your child may also undergo bone marrow biopsy and bone marrow aspiration procedures to see if neuroblastoma has spread to the bone marrow — the spongy material inside the largest bones where blood cells are formed. In order to remove bone marrow for testing, the surgeon inserts a needle into your child's hipbones or lower back and draws out the marrow.
Staging
Once neuroblastoma is diagnosed, your child's doctor may order further testing to determine the extent of the cancer and whether it has spread to distant organs — a process called staging. Imaging tests used to stage cancer include X-rays, bone scans, and CT and MRI scans, among others.
Using the information from those procedures, your child's doctor assigns a stage to the neuroblastoma. Stages of neuroblastoma include:
- Stage I. Neuroblastoma at this stage is localized, meaning it's confined to one area, and may be totally removed with surgery. Lymph nodes connected to the tumor may have signs of cancer, but other lymph nodes don't have cancer.
- Stage IIA. Neuroblastoma at this stage is localized, but may not be as easily removed through surgery. Lymph nodes connected to the tumor may have signs of cancer, but other lymph nodes don't have cancer.
- Stage IIB. Neuroblastoma at this stage is localized and may or may not be easily removed through surgery. Both the lymph nodes connected to the tumor and the lymph nodes nearby contain cancer cells.
- Stage III. Neuroblastoma at this stage is considered advanced, and it isn't possible to remove the tumor through surgery. The tumor may be a larger size at this stage. Lymph nodes may or may not contain cancer cells.
- Stage IV. Neuroblastoma at this stage is considered advanced and has spread (metastasized) to other parts of the body.
- Stage IVS. This stage is a special category of neuroblastoma that doesn't behave like other forms of neuroblastoma, though it isn't clear why. Stage IVS neuroblastoma applies only to children younger than 1 year old. Stage IVS indicates that neuroblastoma has spread to another part of the body — most commonly the skin, liver or limited bone marrow involvement. Despite the extent of neuroblastoma, babies with this stage have a good chance of recovery. Neuroblastoma at this stage sometimes goes away on its own and often doesn't require treatment.
Detecting neuroblastoma during pregnancy
In rare cases, neuroblastoma may be detected during fetal ultrasound before a baby is born. Analysis of the mother's urine can give other clues that may lead doctors to suspect neuroblastoma.
