Neuroblastoma: Treatment Options

How is it treated?

The methods selected to treat Neuroblastoma depend on the severity of the disease. Surgery to remove the tumor and chemotherapy are often used in different combinations. Patients often respond differently to the possible treatments. Sometimes, multiple combinations of different treatments need to be tried.

Surgery:

If Neuroblastoma has not progressed to the more advanced stages, it can sometimes be cured with surgery alone. In these cases, doctors can remove the tumor that is causing the Neuroblastoma. In more advanced cases, surgery is used in conjunction with chemotherapy (described below). Chemotherapy can help to shrink a tumor so that doctors can remove it more easily or it can follow a surgical process to help kill any remaining cancer cells.

Chemotherapy:

Chemotherapy is the use of drugs to kill cancer cells. These drugs can be delivered either orally, in the form of pills, or intravenously, directly into the blood stream through a needle placed into a blood vessel. In chemotherapy, combinations of drugs tend to be more effective than just one type of drug by itself. Patients with early stage Neuroblastoma are often prescribed the drugs known as "carboplatin, cyclophosphamide, doxorubicin, and etoposide." Patients who fall into a higher risk category are often prescribed these drugs in a very high dose in addition to drugs called "ifosfamide and cisplatin."

Chemotherapy drugs can usually be taken in a doctor's office or hospital, or even at home in some cases. Usually, the patient will receive treatment every day for a few weeks. The patient will then have some time off from the medicine in order to build up strength and allow his or her immune system to recover. This cycle can continue until the doctor determines the cancer has stopped spreading or the tumor is beginning to shrink. In the case of Neuroblastoma, the patient may complete 6 to 12 weeks of chemotherapy and up to 24 weeks for more severe cases.

Radiation:

When dealing with Neuroblastoma, radiation is only used in the most severe cases. If a Neuroblastoma patient has tumors that are affecting vital organs and chemotherapy is not acting fast enough, doctors can use radiation to help shrink the tumor. Radiation is also helpful when a life threatening tumor is placed just out of reach of a surgeon. In this form of treatment, high-energy rays are targeted at the tumor area. The energy from the rays works to shrink that particular tumor. The patient usually needs to see a radiologist everyday for a week or two in order to have this procedure done.

Clinical Trials:

In some cases, your doctor may recommend, or you may wish to consider, participating in a Clinical Trial. Clinical Trials are carefully monitored research studies that provide patients with the opportunity to receive the most up-to-date, state-of-the-art care. In a Clinical Trial, new advancements in cancer treatment are compared to the current, most effective existing treatment. All participants are either treated with an existing and effective method, or with a new, innovative method. Patients in trials have access to the newest drugs, procedures, and treatments. While the side effects of Clinical Trials depend on the exact treatment used, patients who have participated in Clinical Trials in the past have found their experience to be valuable. Clinical Trials are being conducted in cities and towns across the country, and often times, Clinical Trial covers many of the costs. Your doctor or health care provider can give you more information on Clinical Trials in your area. You may also contact the Rhode Island Cancer Council who can help you find a Clinical Trial in your area.

What are the side effects of the treatments?

Surgery:

After surgery, the patient may experience pain at the sight of the incision. Your child may also complain of a general feeling of weakness from the procedure. Both of these side effects are temporary and can be treated with pain medication, over the counter or prescribed, as well as plenty of rest.

Depending on the location of the tumor removed, your child may experience temporary or permanent limited movement or function following the surgery. Your doctor will be able to tell you what to expect.

Chemotherapy:

The medicine used in chemotherapy targets and kills the cancer cells in the body. Cancer cells are identified by the medicine as those cells that divide rapidly. Many times, chemotherapy not only kills these cancer cells, but it can damage or even reduce the number of normal, healthy cells in the body, in particular, those healthy cells which divide rapidly.

These cells include:

• The lining of the digestive tract, including the inside of the mouth and the cells in the intestines.
  
• The immune cells located in the bone marrow.
  
• The cells responsible for hair growth on various parts of the body (hair follicles).
  

As a result, a chemotherapy patient may experience some side effects such as sores inside the mouth, digestive problems such as loss of appetite or nausea and vomiting. Patients also tend to experience hair loss as a result of chemotherapy. The immune system also suffers because the body is less able to fight off infection and produce blood cells. A lack of red blood cells may also result in fatigue and a decrease in platelets can cause easy bruising. These side effects are, for the most part, temporary and will go away when the chemotherapy is stopped. Some of the permanent side effects include early menopause in women and infertility in both men and women.

Radiation:

Patients undergoing radiation therapy often complain of feeling tired. The radiation exposure can also cause a patient's skin to become red or dry, especially in areas that are exposed to the cold air or sun, or where clothing may rub. You should avoid using any creams or lotions unless your doctor prescribes them. Wearing loose, soft, comfortable clothing and avoiding extreme hot or cold temperatures can help with this. Also, the radiation can affect various parts of the body, depending on the location of the tumor. For instance, if the digestive system is exposed to radiation because the tumor is located in the lower back, the patient may experience some digestive problems.

Follow up:

Following cancer treatment, it is important for children who are recovering from Neuroblastoma to remain healthy. Most children visit a doctor every 3 to 4 months immediately after the treatment program, and then every year or so after that. You and your child will need to keep your doctor updated long after the treatment has ended. It is a possibility that the cancer may return, or another type of cancer may develop. Both you and your child can monitor your child's health carefully, noting changes or signs of improvement or recurrence. Healthy foods in a balanced diet, as well as plenty of sleep and exercise, will help your child recover quickly and remain healthy.

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