Neuroblastoma: Prognosis and Life Expectancy
When a parent is told their child has neuroblastoma, cancer that involves nerve tissue, the world may seem like it’s stopped turning. There are so many questions. How will their child be treated? What is the prognosis for neuroblastoma? What is life like after treatment? While each affected child is different in terms of the cancer and treatment options, keep reading to learn the basis of neuroblastoma prognosis and life expectancy, including neuroblastoma stage and risk group.
When a child is diagnosed with neuroblastoma, staging is the next step. Staging tells the oncologists how far along the cancer has spread and how best to treat it. It is also an important part in determining a patient’s prognosis. Younger children, those younger than 18 months, usually have a better long-term outcome than older children.
Pediatric oncologists look at many aspects of the tumor, such as how the cancer cells look under the microscope. Typically, tumor cells that look more like normal cells (a ‘favorable’ histology) bear a better outlook than cells that look more abnormal (an ‘unfavorable’ histology).
Doctors also look at the cells’ DNA; particularly, whether there are extra copies of a gene called MYCN. This particular gene helps cancer cells grow faster, so when there are extra copies, the cancer can be more aggressive. Once the doctor has that information, they can assign a stage and a prognosis.
Cancer survival rates are usually listed as the percentage of people alive five years after their diagnosis. This is the five-year survival rate. For children with neuroblastoma, the five-year survival rate depends on the risk group the child is in and what stage the cancer has reached.
In some cases, the doctor determines the exact stage and risk group after surgery to remove the tumor.
Here are the possible stages of neuroblastoma:
- Stage 1: Stage 1 neuroblastoma is still contained in the original location and all of the tumor that can be seen has been surgically removed. Cancer cells have not gone to the lymph nodes.
- Stage 2A: Stage 2A neuroblastoma means some of the tumor remains after surgery and the lymph nodes closest to the tumor may have some neuroblastoma cells, but there are no tumors in the nodes. The cancer is still in its original location.
- Stage 2B: A stage 2B neuroblastoma means the tumor is still on one side of the body and in the closest lymph nodes, but it has not spread to the other side of the body or to lymph nodes further away.
- Stage 3: Although the cancer has not metastasized (spread) throughout the body, a stage 3 neuroblastoma diagnosis means the tumor has moved to the other side of the original location. It also has spread to other lymph nodes. The tumor cannot be removed by surgery.
- Stage 4: Stage 4 neuroblastoma is metastatic disease. The cancer has spread to other organs and other parts of the body, such as the bone marrow.
- Stage 4S: This stage is given to children who are younger than 12 months, with cancer on one side of the body, and may have spread to the liver, skin or bone marrow. Unlike other stages, only 10% of the cells in the bone marrow are cancerous in a child with stage 4S neuroblastoma.
Oncologists estimate the survival of patients with neuroblastoma according to their risk group: low, intermediate and high.
The low-risk groups include children with the lower stages, including:
- Children in stage 1
- Children under 12 months in either stage 2A or 2B
- Children over 12 months in either stage 2A or 2B but no extra MYCN copies
- Children in stage 4S who don’t have extra MYCN gene copies, and the cells look favorable
Children in this group have a five-year survival rate of over 95%. It means that a child in the low-risk group is 95% as likely, on average, as a child without neuroblastoma to live at least five years after diagnosis.
Intermediate-risk group children are those under 12 months who have stage 3 or stage 4 neuroblastoma but no extra copies of the MYCN gene, have favorable histology, and older children without extra MYCN gene copies and whose cancer looks ‘favorable’ under the microscope. Children with stage 4S neuroblastoma containing cells that seem to have normal chromosomes are also in this group.
The children in this group have a five-year survival rate between 90% and 95%.
High-risk group children are those with an advanced stage of neuroblastoma (stage 3 or 4), extra copies of the MYCN gene, unfavorable histology, and other findings in the DNA. These children have a five-year survival rate of 40 to 50%.
When parents receive information regarding life expectancies and survival rates, it’s important to understand the values are averages. Today’s survival rates are based on the outcomes of patients from at least five years prior. Survival rates also don’t predict how long an individual will live, but they can give you a sense of treatment success. Some children do better than the average, others do not. Some children respond better to treatment than others, possibly ‘beating the odds.’ And, as research into neuroblastomas continues, newer treatments can change the prognosis.
Talk with the treatment team about how your child’s treatment plan affects prognosis and survival rate.