Table of Contents

    1.    What is neuroblastoma?
    2.    Neuroblastoma symptoms: early signs parents may notice
    3.    Neuroblastoma diagnosis: VMA/HVA tests, imaging & biopsy
    4.    INRG staging (L1, L2, M, MS) and risk groups
    5.    Neuroblastoma treatment by risk level
    6.    High-risk neuroblastoma: intensive therapy & anti-GD2 immunotherapy
    7.    Prognosis and survival rate
    8.    Genetic testing (ALK, PHOX2B, MYCN)
    9.    Follow-up care: life after treatment
  10.    How RecMed supports families in Türkiye
  11.    FAQs about neuroblastoma
  12.    References

What is neuroblastoma?

Neuroblastoma is a childhood cancer that starts in immature nerve cells, most often in the adrenal glands or along the spine. It is one of the most common solid tumors in children, usually diagnosed before the age of 5.

Neuroblastoma symptoms: early signs parents may notice

    •    Abdominal swelling or palpable mass
    •    Bone pain or limping
    •    Bruising around the eyes (“raccoon eyes”)
    •    Loss of appetite, weight loss
    •    High blood pressure, flushing, sweating
    •    Neurological problems such as weakness or imbalance

Neuroblastoma diagnosis: VMA/HVA tests, imaging & biopsy

    •    Urine/blood tests: vanillylmandelic acid (VMA) and homovanillic acid (HVA)
    •    Imaging: ultrasound, MRI, CT, ^123I-MIBG scan (or FDG-PET if MIBG-negative)
    •    Bone marrow biopsy to check for spread
    •    Pathology/genetics: MYCN amplification, ALK and PHOX2B mutations

INRG staging (L1, L2, M, MS) and risk groups

    •    L1: localized, no image-defined risk factors (IDRFs)
    •    L2: localized, with IDRFs
    •    M: metastatic disease
    •    MS: special metastatic pattern in infants (skin, liver, limited marrow)

Neuroblastoma treatment by risk level

    •    Low-risk: surveillance or surgery
    •    Intermediate-risk: chemotherapy + surgery
    •    High-risk: intensive therapy — induction chemotherapy, surgery, high-dose chemo + autologous stem cell rescue, radiation, isotretinoin, and anti-GD2 immunotherapy (dinutuximab, naxitamab)

High-risk neuroblastoma: intensive therapy & anti-GD2 immunotherapy

High-risk disease requires multimodal therapy. Anti-GD2 antibodies significantly improve survival. Relapsed/refractory cases may receive MIBG therapy or ALK inhibitors.

Prognosis and survival rate

    •    Low-risk: >90% survival
    •    Intermediate-risk: 70–90% survival
    •    High-risk: <50% long-term survival, though improving with new therapies

Genetic testing (ALK, PHOX2B, MYCN)

    •    MYCN amplification → aggressive disease
    •    ALK / PHOX2B mutations → hereditary syndromes and potential for targeted therapy

Follow-up care: life after treatment

Survivors need long-term monitoring for:
    •    Hearing loss
    •    Hormonal/growth disorders
    •    Fertility concerns
    •    Second cancers

How RecMed supports families in Türkiye

At RecMed Medical Travel (Istanbul), we provide:
    •    Full diagnostic work-up (VMA/HVA, MRI/CT, MIBG, marrow biopsy)
    •    Multidisciplinary treatment planning
    •    Access to advanced therapies (anti-GD2, MIBG therapy, stem cell rescue)
    •    Comprehensive family support including translation and logistics

FAQs about neuroblastoma

What is an MIBG scan? A nuclear medicine test detecting neuroblastoma cells.
Is neuroblastoma curable? Yes, especially low- and intermediate-risk groups.
What is MYCN amplification? A genetic marker of aggressive tumor biology.

References

    1.    National Cancer Institute (NCI). Neuroblastoma Treatment (PDQ®) – Health Professional Version. Updated 2024. Available: https://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq
    2.    American Cancer Society (ACS). Neuroblastoma in Children. 2024. Available: https://www.cancer.org/cancer/neuroblastoma.html
    3.    Cohn SL, Pearson AD, London WB, et al. The International Neuroblastoma Risk Group (INRG) Classification System. J Clin Oncol. 2009;27(2):289–297. doi:10.1200/JCO.2008.16.6785
    4.    Park JR, Bagatell R, Cohn SL, et al. Revised International Criteria for Neuroblastoma Response. J Clin Oncol. 2017;35(22):2580–2587.
    5.    Ladenstein R, et al. Immunotherapy with anti-GD2 antibody in high-risk neuroblastoma. N Engl J Med. 2018;378:1234–1244