Neuroblastoma: Year of the Zebra 2024

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Introduction0:00–1:18

Neuroblastoma is a type of cancer that arises from neural crest cells which are cells involved in the development of the nervous system.
Normally, neural crest cells migrate throughout the body to form a range of structures including the sympathetic chain ganglia nerve cells that lie on either side of the spinal cord and the adrenal medulla.
The innermost part of the adrenal gland with neuroblastomas. Some of these neural crest cells do not mature properly during fetal development and instead continue to divide in their immature state until they form a tumor.
Most commonly neuroblastomas form in the adrenal medulla, but they can also develop in other areas of the sympathetic chain, including the neck, chest abdomen or near the spine.
These tumors typically affect infants and are rarely seen in Children over five years old. Well, no one knows the exact cause.
This abnormal cell development has been associated with mutations in growth regulating genes such as M YC A LK and Fox two B genes.
Clinical manifestations of A neuroblastoma depend on the location and size of the tumor. For example, a tumor in the adrenal glands can present with a large painful abdominal mass that causes abdominal swelling.

Clinical Manifestations1:18–2:33

Whereas a tumor in the chest can grow into the lungs causing breathing difficulties and abnormal breath sounds, tumors near the spine may compress one or more spinal nerves causing neurologic symptoms like muscle weakness and bowel or bladder dysfunction.
Similarly, tumors in the neck can press on the nerves originating from that region, resulting in a collection of symptoms known as Horner Syndrome.
Horner syndrome may result in a drooping eyelid, small pupil in one eye and decreased sweating on one side of the face. About half of all neuroblastomas spread to the bones causing bone pain and an increased risk of fractures.
Neuroblastomas can also invade the lymph nodes in bone marrow, affecting its ability to produce healthy blood cells. This can lead to fatigue, easy bruising and frequent infections.

Diagnosis2:33–3:20

Diagnosis of a neuroblastoma involves a combination of laboratory and imaging tests. Lab tests typically show elevated levels of sympathetic hormones like adrenaline and its metabolites.
Homovanillic and vanillylmandelic acid. These are often detected in the urine using specific tests.
An abdominal CT or ultrasound scan can show the location and size of the tumor and a complete blood count can help determine whether it has spread to the bone marrow.
Other tests such as a pet scan or an M IG scan, which use radioactive substances to identify cancer cells may be performed as part of the staging process.

Treatment3:20–4:05

Treatment of a neuroblastoma depends on the size of the tumor and whether it has spread to other body sites. Infants with small low risk tumors may not need specific treatment.
Other than observation, as some of these tumors go away on their own for older Children. And those with intermediate or high risk disease treatment typically involves a combination of surgery, chemotherapy and radiation therapy.
In cases where neuroblastoma relapses, chemotherapy may be followed by a bone marrow transplant or newer medications like naxitamab, a medication that specifically targets cancer cells in neuroblastoma.

Review4:05–4:33

All right. It's a quick recap.
Neuroblastoma is a childhood cancer that develops when neural crest cells do not mature properly and continue to proliferate in an immature state.
Creating tumors that press on nearby organs. Diagnosis is based on laboratory and imaging tests and treatment depends on the size and stage of the tumor, including a combination of surgery, chemotherapy, radiation therapy and immunotherapy.