Neuroblastoma

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Colleen Mathews from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description

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Prevalence

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Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

Neuroblastoma left untreated can metastasize to other systems in the body mentioned above in the Characteristics/Clinical Presentation. The multiple systems can be affected by a primary or a metastasized tumor. Treatments for neuroblastoma such as chemotherapy and radiation can affect multiple systems. The following systems can be affected including; Nervous System, Musculoskeletal System, Gastrointestinal System, Urogenital, and Cardiopulmonary, Reproductive, and Integumentary System.

Medical Management (current best evidence)

See Medications.

Physical Therapy Management (current best evidence)

Quality of life is an important theme when it comes to treating children with neuroblastoma and any form of childhood cancer. Side effects of the cancer treatment/medication (chemotherapy, radiation, etc.) and symptoms of the cancer itself can lead to a risk of the following musculoskeletal and neurological issues.

• Neurological changes including (peripheral neuropathy and radiculopathy)
• Musculoskeletal changes (disuse atrophy and joint contractures due to radiation fibrosis)
• Developmental Delay
• A generalized effect of decrease in endurance, increase fatigue, and decreased strength

The effects are not isolated to physical losses, but also include psychosocial changes as well. The following are included in psychosocial considerations when treating a child with neuroblastoma and cancer.

• Depression and anxiety
• Poor self-esteem
• Loss of purpose (due to the fact that most have changes in school life, social changes, and family life)
• Social Isolation
• Behavioral Issues

Research has also found late effects of childhood cancers including the following presentations.

• Sensory changes (eyesight changes and hearing loss)
• Developmental Changes (learning disabilities and functional deficits)
• System Changes (reproductive issues, cardiopulmonary disease, osteoporosis, uneven growth of limbs, and    decreased overall growth)
• Increased risk of secondary cancer

The above presentations are important in screening and for determining the physical therapy treatment of a child who presents with cancer or neuroblastoma. Physical therapy treatment should include a variety of considerations to address the limitations or deficits of the individual patient. Therapists can utilize when possible, group therapy to decrease social isolation and to develop psychosocial benefits. Wii rehabilitation treatment can address many deficits in the child with cancer such as balance, strength, and endurance. Overall, PT treatment has been proven through research to benefit the quality of life in a cancer patient of either a terminal or treatable diagnoses.

Alternative/Holistic Management (current best evidence)

None found thus far that is supported by current evidence.

Differential Diagnosis

Stages of Neuroblastoma:

Stage 1: The percentage of children diagnosed at this stage is 21%.

The primary tumor is located and isolated to one area of the body. The lymph nodes bilaterally are negative for cancer. The neuroblastoma cancer in this stage can be removed by surgery. Microscopic residual cancerous tissue may remain after removal of the tumor.

Stage 2: The percentage of children diagnosed at this stage is 15%

2A: The primary tumor at this stage is confined to one area. However, it cannot be completely removed through surgery because of its larger size, proximity to other organs, or general location. The lymph nodes are negative bilaterally on both sides of the body for metastases.

2B: The primary tumor at this stage is confined to one area of the body. The tumor may or may not be completely surgically removed. The lymph nodes on the side of the body where the tumor is located are positive for metastasis of neuroblastoma. The lymph nodes on the opposite side of the body are negative for metastasis.

Stage 3: The percentage of children diagnosed at this stage is 17%.

The following descriptions of presentations are Stage 3. The first presentation of stage 3 is the primary tumor crosses the spinal cord region/midline of the body. The lymph nodes may or may not present with metastasis. The second presentation of stage 3 could be the primary tumor is located on one side of the body, while metastasis is found in the lymph nodes on the opposite side of the body. The third presentation of stage 3 could be the primary tumor is located on one side of the body while metastasis is found bilaterally in the lymph nodes.

Stage 4: The percentage of children diagnosed at this stage is 41%.

This stage presentation is neuroblastoma cells are found in the distal lymph nodes, liver, bone marrow, or additional organs.

Stage 4S: The percentage of children diagnosed at this stage is 6%.

The presentation at this stage is typically in infants. The primary tumor is isolated to one area of the body, but the tumor has metastasized to other regions of the body such as bone marrow, liver or skin. Bone metastasis is rare in this category, with less than 10%.

Additional Differential Diagnosis: Osteosarcoma, Ewing’s Sarcoma, Ganglioblastoma.

Case Reports/ Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

Resources

• http://www.mayoclinic.com/health/neuroblastoma/DS00780
• http://www.curesearch.org/
• http://www.cancer.org/Cancer/Neuroblastoma/DetailedGuide/index
• http://www.cancercare.org/get_help/help_by_diagnosis/diagnosis.php?diagnosis=pediatric

Recent Related Research (from Pubmed)

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References

see adding references tutorial.