How is Neuroblastoma Treated?
Decisions about treatment plans should be made by parents and the child's healthcare providers together. The treatment chosen should consider a number of factors:
- The child's age, medical history and overall health
- Extent of the disease
- The child's tolerance for specific medications, procedures or therapies
Treatment includes a wide range of approaches. Depending on individual circumstances, one or more of these approaches are used either alone or in combination:
- Surgery to remove the primary tumor (the main or first tumor, if there are more than one)
- Chemotherapy
- Radiation therapy
- Blood and marrow transplant
- Immunotherapy
Each treatment has both benefits and side effects. Your child’s doctors will closely monitor side effects and give supportive care. Antibiotics may be prescribed to prevent or treat infections.
New methods are continually being discovered to improve treatment approaches and decrease side effects.
Surgical Treatment of Neuroblastoma
The goal of surgery is to remove as much of the tumor as possible. Partial removal may be needed if the tumor is unable to be separated from vital structures (such as blood vessels or nerves). The remaining tumor can then be treated through other methods like chemotherapy or radiation. Determining whether surgery is the best treatment option versus other treatments like chemotherapy depends on several factors. These include:
Information About the Tumor
- Location—Where is it in the body? Is it in the abdomen, chest, neck, or somewhere else?
- Size—How big is the tumor? Larger tumors might be more challenging to remove.
- Nearby organs—Is it close to organs or blood vessels?
How Far the Cancer has Spread
- Cancer stage—Has it stayed in one place (localized) or spread to other areas (advanced)?
- Other tumors—Are there additional tumors in other parts of the body that might need attention?
The Child's Health
- Overall condition—How strong and healthy is the child? Can they safely undergo a major surgery?
- Age—Very young children might need special considerations during surgery.
- Previous treatments—If the child had chemotherapy first, how did they respond? This can influence the timing and approach of surgery.
The Overall Treatment Plan
- Timing—When is the best time for surgery in relation to other treatments like chemotherapy or radiation?
- Goals—Is the aim to remove the entire tumor or take a sample for further testing?
- Future treatments—How might surgery affect or be affected by planned follow-up care?
What Happens During Surgery?
Before surgery begins, your child will be placed under general anesthesia. This means they’ll be asleep throughout the procedure and not feel pain. Once the anesthesia takes effect, the surgeon will make an incision (cut) to access the tumor.
The type of incision will depend on the location of the neuroblastoma and the extent of the cancer. In some cases, a laparoscopic or robotic procedure may be used. Laparoscopic surgery involves making several small incisions instead of one large one. A thin tube with a camera and surgical instruments is put through these small incisions, allowing the surgeon to operate without making a large cut. A robotic procedure is like a laparoscopic procedure, but a robot is used by the surgeon to improve how well they can see all parts of the tumor.
Depending on the location of the tumor and the extent of the cancer, the surgeon may also need to remove nearby lymph nodes or other tissues. The incision may range from less than an inch to several inches, depending on how much of the tumor needs to be removed.
How Long Will the Surgery Take?
The length of the surgery typically lasts between three to six hours. This can vary based on how complicated the procedure is. The surgeon will give you a specific time frame based on your child’s case.
What Does Recovery After Surgery Look Like?
After surgery, most children stay in the hospital for several days. The length of the stay depends on the extent of the surgery and how quickly they recover. During this time, the medical team will closely watch your child for signs of infection or complications such as bleeding or damage to nearby organs or nerves. Pain management will be provided to keep them as comfortable as possible.
What Is the Enhanced Recovery After Surgery (ERAS) Protocol?
The recovery time after surgery will vary depending on the type of surgery, the tumor size, and the child's overall health. Enhanced Recovery After Surgery (ERAS) is a special set of steps taken to help patients feel better , leave the hospital sooner and have fewer problems after surgery.
