Signs of Relapse of Neuroblastoma

Last Modified: December 18, 2005

Dear OncoLink "Ask The Experts,"

My daughter was diagnosed with Neuroblastoma Stage IV S, at two weeks old in November of 2000. The following 3 years she received aggressive chemotherapy, stem cell harvest, bone marrow transplant, and finally, the treatment that put her in remission: "HAMA Antibody". She has been in remission for the last two years, continues to see the doctor on a quarterly basis, and receives HAMA Antibody whenever her antibody level is low. My question is: what are the signs of a relapse?

Amit Maity, MD, PhD, Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:

When neuroblastoma recurs, it often recurs in the bone. This would generally be manifested by pain in the affected site. In a very small child who is not able to express that s/he is in pain, this may be manifested by irritability or an inability to walk/crawl. Sometimes the bones around the eyes may be affected, which can result in bulging of the eye (proptosis) or bruises around the eyes ("raccoon eyes").

Recurrent neuroblastoma can also come back as masses in the abdomen, bone marrow involvement, liver involvement, or nodal involvement. Recurrence in these sites may be suspected by routine studies (such as a CT scan of the abdomen or a blood count) before the child actually develops symptoms. However, if the recurrent tumor gets large enough, it may cause symptoms that bring the child to medical attention. For example, a large abdominal mass may cause intestinal obstruction (accompanied by lack of bowel movements and/or vomiting) or a palpable mass. Bone marrow involvement may lead to decreased white blood cell count (predisposing to infections), decreased red blood cell count (resulting in fatigue) and decreased platelet count (accompanied by easy bruising or difficulty with forming a blood clot after bleeding from a cut). Small children may also have a general "failure to thrive" from widespread recurrent neuroblastoma (poor appetite, inability to gain weight).