Neuroblastoma (Childhood Nerve Cancer), from the CureRays guide library.

Neuroblastoma is a cancer of early nerve cells that affects young children; treatment is matched to risk, ranging from observation to intensive therapy, and radiation plays an important role in high-risk disease.

What it is.

Neuroblastoma is a cancer that develops from neuroblasts — immature nerve cells left over from a baby's development. It is one of the most common cancers in infants and young children, usually diagnosed before age 5, and rarely occurs in older children or adults. Because these early nerve cells are part of the sympathetic nervous system, neuroblastoma can start in several places: most often in the adrenal glands on top of the kidneys, but also along the chain of nerve tissue beside the spine in the abdomen, chest, neck, or pelvis. Symptoms depend on where the tumor is and whether it has spread — a child may have a swollen belly or a lump, bone pain, fever, fatigue, bruising around the eyes, or other signs. Neuroblastoma behaves very differently from child to child: some tumors, especially in babies, can mature or even disappear on their own with little or no treatment, while others are aggressive and need intensive therapy. Because of this wide range, doctors carefully sort each child into a risk group that guides treatment. Care is delivered by a specialized children's cancer team, and radiation therapy — including a special form that seeks out neuroblastoma cells throughout the body — is an important tool, especially for high-risk disease.

How radiation treats it.

Radiation uses focused high-energy beams to damage the DNA inside cancer cells so they can no longer grow and divide. Neuroblastoma is sensitive to radiation, so it is an important tool — but it is used selectively, mainly for high-risk disease, where radiation to the original tumor site and to areas of spread helps keep the cancer from coming back after chemotherapy and surgery. Because the patients are young children whose bodies are still growing, radiation oncologists plan treatment with great care to protect the spine, kidneys, liver, and other organs, sometimes using proton therapy to reduce the dose to healthy tissue. Neuroblastoma also has a special, almost unique option: MIBG therapy, a radioactive medicine given through a vein that is absorbed specifically by neuroblastoma cells throughout the body, delivering targeted radiation directly to the cancer wherever it hides. Standard radiation treatments are quick and painless, given over a small number of short daily sessions, and young children may have gentle sedation to help them stay still. Side effects are watched closely by the children's cancer team, with special attention to long-term growth and health. Your child's team will explain exactly where radiation fits in the overall plan.

The ways we can treat it.

External-beam radiation to the tumor bed. Targeted radiation to the area where the tumor was removed treats any cancer cells left behind; it is carefully shaped to protect a young child's growing spine, kidneys, and other organs.

MIBG targeted radiation therapy. A radioactive medicine called MIBG is given through a vein and is taken up specifically by neuroblastoma cells throughout the body, delivering radiation directly to the cancer wherever it is — a form of theranostic, targeted radiation used in selected high-risk or relapsed cases.

Proton therapy. Proton beams deliver radiation to the target while reducing dose to growing bones and nearby organs, lowering the risk of long-term side effects in children.

Questions we hear often.

Can neuroblastoma be cured? Often, yes. Outcomes depend heavily on the risk group. Children with low- and intermediate-risk neuroblastoma usually do very well, and some infant tumors even shrink on their own. High-risk disease is more challenging, but intensive modern treatment — including chemotherapy, surgery, radiation, transplant, and immunotherapy — cures many children and continues to improve.

Why do two children with neuroblastoma get such different treatment? Neuroblastoma varies enormously from child to child. Doctors combine the tumor's stage with the child's age, how the cells look, and genetic features such as the MYCN gene to assign a risk group. A low-risk child may need only surgery or observation, while a high-risk child needs intensive combined therapy — which is why plans differ so much.

What is MIBG therapy? MIBG is a special targeted radiation treatment. It is a radioactive medicine given through a vein that neuroblastoma cells absorb specifically, delivering radiation directly to the cancer cells throughout the body wherever they are. It is used in selected high-risk or relapsed cases, and your child's team will explain whether it is part of the plan.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.