If a child is presenting with a group of the above symptoms, commonly physicians will first assess for a virus. Once that has been ruled out, blood work will typically be ordered; lab results will typically give clues that something serious is going on with the child.
If cancer is a concern, urine tests, imaging studies, and tissue samples will be needed.
Catecholamines are the main group of neurotransmitters produced by cells of the sympathetic nervous system. The body breaks down the catecholamine molecules into metabolites, or smaller pieces, and they are passed out of the body in the urine.
In almost all cases of Neuroblastoma, patients present with elevated levels of catecholamines. Some of the symptoms associated with Neuroblastoma -- such as high blood pressure -- are caused by increased catecholamines.
It is important to keep in mind that often times urine testing for catecholamines is a fast and simple screener – not all children with elevated levels will have cancer – though most children with cancer will have increased levels. A child who has elevated levels needs further testing.
Computed tomography (CT) is the most common method for assessing the presence of tumors – CT scanning is likely ordered after urine testing reveals elevated levels, or after more simplistic imaging such as an ultrasound shows some sort of mass.
Once Neuroblastoma has been confirmed via imaging analysis, a common next step is tissue biopsy so that staging and risk can be computed and treatment can begin. Staging: is determined by tumor presence and metastases; according to the International Neuroblastoma Staging System:
Stage 1: local tumor only with complete excision, no lymph node involvement
Stage 2: local tumor only without complete excision, possible lymph node involvement
Stage 3: unresectable tumor crossing the midline with or without lymph node involvement
Stage 4: tumor with metastases to distant organs, bone marrow and/or lymph nodes
Stage 4S: local tumor in infants less than one year with limited dissemination (only about 5 percent of cases)
Risk is commonly defined as whether or not the cancer has N-myc amplification. N-myc is an oncogene; amplification means that more than one copy is found in the cell. N-myc amplified Neuroblastoma presents a challenging treatment situation and is often associated with poor treatment outcome.