Clinical Staging

As with other cancers, clinical staging of neuroblas-toma is useful for prognostication and for comparing results of treatments carried out by different groups. Staging is a particularly important factor for classifying cases as intermediate risk. The issue is straightforward for infants with classic stage 4, which is one of the most obvious and dramatic clinical pictures in oncology: a previously well baby becomes irritable and is found to harbor a large abdominal tumor, sizeable metastatic deposits in bones, and numerous syn-cytial clumps of tumor cells in bone marrow. Other major phenotypes within the intermediate-risk category, however, are dependent on features of the primary tumor. For example, tumor resectability is a key factor in distinguishing stage 3 (intermediate risk)

from stage-1 or stage-2 disease (low risk, no chemotherapy). Yet, tumor resectability is hard to determine by imaging studies and can be influenced by subjective factors such as a surgeon's experience and the acceptance by many oncologists and surgeons of the necessity to use chemotherapy to shrink a large tumor.

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