Neuroblastoma

Neuroblastoma is a type of tumor composed of “neuroblasts,” specifically neural crest cells, which are cells involved in the development of the sympathetic nervous system.

Neuroblastoma is the most common cancer in infants, and it’s only rarely seen in children over five years old.

When a fetus is in its 5th week of development, special cells called neural crest cells start migrating along the spine.

In the thoracic region of the spine, neural crest cells differentiate into the neurons of the sympathetic chain, lying on either side of the entire spinal cord.

In the lumbar region, neural crest cells differentiate into the cells of the adrenal medulla, the inner part of the adrenal gland that sits atop the kidneys.

Together, the sympathetic chain and adrenal medulla form the sympathetic nervous system, connecting the brain and central nervous system to various organs including the heart and blood vessels.

So, when you’re under some sort of stress, like playing a competitive sport like badminton, the sympathetic nervous system kicks into action.

The sympathetic neurons releases norepinephrine, also called noradrenaline, and the cells of the adrenal medulla release norepinephrine and epinephrine, also called adrenaline.

These hormones bind to receptors in various tissues like the blood vessels, the heart, and the lungs, redirecting blood flow to your muscles, make your heart pump faster, and expanding the airways in your lungs, all of which can help you make the winning hit.

After the game is over, and the hormones are no longer needed, epinephrine and norepinephrine break down into metabolites like homovanillic acid or HMA, and vanillylmandelic acid, or VMA.

In neuroblastoma, some neural crest cells in the sympathetic chain or adrenal medulla don’t differentiate properly during fetal development, and these cells ultimately go on to form a tumor, which most often form in the adrenal medulla, but can also develop in other areas of the sympathetic chain.

While no one knows exactly how it happens, this abnormal cell differentiation has been associated with mutations in the MYCN oncogene, Anaplastic lymphoma kinase ALK fusion oncogenes, and mutations in tumor suppressor genes, like the Paired-like homeobox 2b or PHOX2B, and other tumor suppressor genes on chromosome 1 and 11.