Screening of neuroblastoma

Attempts have been made to detect neuroblastoma within the first year of life by screening for raised urinary catecholamines. Almost invariably the tumours detected by screening are localized and of favourable biology and there is a significant incidence of spontaneously resolving

Table 21.2 International staging system for neuroblastoma

Stage 1 Localized tumour with complete gross excision, with or without microscopic residual disease; representative ipsilateral and contralateral lymph nodes negative for tumour microscopically (nodes attached to and removed with the primary tumour may be positive).

Stage 2a Localized tumour with incomplete gross excision;

representative ipsilateral and non-adherent lymph nodes negative for tumour microscopically.

Stage 2b Localized tumour with complete or incomplete gross excision;

with ipsilateral non-adherent lymph nodes positive for tumour. Enlarged contralateral lymph nodes must be negative microscopically.

Stage 3 Unresectable unilateral tumour infiltrating across the midline with or without regional lymph node involvement; or localized unilateral tumour with contralateral regional lymph node involvement; or midline tumour with bilateral extension by infiltration (unresectable) or by lymph node involvement.

Stage 4 Any primary tumour with dissemination to distant lymph nodes,bone,bone marrow,liver skin,and/or other organs (except as defined in Stage 4S).

Stage 4S Localized primary tumour (as defined for Stage 1, 2a, or 2b) with dissemination limited to skin,liver,and/or bone marrow (limited to infants less than one year old).

neuroblastoma at this age. Screened patients have double the expected incidence of the disease. There is no evidence that the detection of tumours by this method, for this age group, reduces the incidence of unfavourable biology or metastatic tumours during the following 2-3 years. Screening at a later age is under consideration.

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