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==Prognosis==
==Prognosis==
The prognosis of neuroblastoma is poor and it depends on the following:
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis of neuroblastoma is generally regarded as poor.
:*Whether or not the tumor can be removed by surgery.
* The table below lists the prognostic factors for neuroblastoma patients:<ref name="radio">Neuroblastoma. Radiopaedia(2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 5 2015</ref><ref name="wiki">Neuroblastoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Neuroblastoma Accessed on October, 5 2015</ref><ref name="gov"> Neuroblastoma Treatment for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#link/_534_toc Accessed on October, 7 2015</ref><ref name="patho"> Neuroblastoma. Libre Pathology(2015) http://librepathology.org/wiki/index.php/Adrenal_gland#Neuroblastoma Accessed on October, 5 2015</ref>
:*The stage of the cancer: the size of the tumor, whether the cancer has spread
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1100px"
:*The child’s general health
|valign=top|
=== Post-treatment prognosis ===
|+
After it is declared that the disease is gone, it often comes back. Further treatment is then required. This can be problematic because some treatments, such as [[chemotherapy]], have cumulative effects and side-effects therefore can increase significantly if used again.
! style="background: #4479BA; width: 200px; color: #FFFFFF;"|'''Prognostic Factor'''


Intensive chemotherapy and [[radiation therapy]] have known long-term negative consequences.  An estimated two of three survivors of childhood cancer will ultimately develop at least one chronic and sometimes life-threatening health problem within 20 to 30 years after the cancer diagnosis.<ref>[http://www.ajc.com/health/content/shared-auto/healthnews/-bon/602068.html "Childhood Cancer Survivors Face Increased Sarcoma Risk"], HealthDay News, February 21, 2007</ref><ref>Oeffinger et al.,[http://content.nejm.org/cgi/content/abstract/355/15/1572 "Chronic Health Conditions in Adult Survivors of Childhood Cancer"], New England Journal of Medicine, October 12, 2006</ref>
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''


===Criteria===
|-
When the [[lesion]] is localized, it is generally curable. However, long-term survival for children with advanced disease is poor despite aggressive multimodality therapy.
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Patients Age'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:Patients older than 18 months of age are associated with poor prognosis.
 
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center| '''Tumor Stage'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:Advanced INSS stages of neuroblastoma are associated with poor prognosis.
 
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center| '''Tumor Grade'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:An unfavorable Shimada histology index is associated with poor prognosis.
 
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center| '''Schwannnian Stroma'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:A reduced schwannian stroma background content on histological analysis is associated with poor prognosis.
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center| '''Mitotic-karyorrhectic Index'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:A high mitotic-karyorrhectic index is associated with poor prognosis.
 
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center| '''Genetics Mutations'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:Chromosome 1p deletion, chromosome 11q deletion, and N-MYC oncogene amplification are associated with poor prognosis.
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center| '''Response to Treatment'''|| style="padding: 5px 5px; background: #F5F5F5;" |
:Patients whose neuroblastoma responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment.
|}


Recent biologic and genetic characteristics have been identified, which, when added to classic clinical staging, has allowed accurate patient assignment to risk groups so that treatment strategies can be more effectively undertaken. These criteria include the age of the patient, extent of disease spread, microscopic appearance, and several other biological features, most importantly MYCN oncogene amplification, into low, intermediate, and high risk disease.  The therapy for these different risk categories is very different. Low risk patients can frequently be observed without any treatment at all, while intermediate risk patients are treated with chemotherapy.  High-risk neuroblastoma is treated with intensive chemotherapy, surgery, radiation therapy, bone marrow /[[Hematopoietic stem cell transplantation]] and biological-based therapy with Cys-Retinoic acid (Accutane). With current treatments, patients with low and intermediate risk disease have an excellent prognosis with cure rates above 90%. In contrast, therapy for high-risk neuroblastoma results in cures only about 30% of the time.


==References==
==References==

Revision as of 15:46, 11 October 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Natural History

Complications

  • Treatment-resistant diarrhea (vasoactive intestinal peptide secretion, among 4% of cases)
  • Horner's syndrome (cervical sympathetic chain compression, among 2.4% of cases)
  • Opsoclonus myoclonus syndrome and ataxia (paraneoplastic syndrome, among 1.3% of cases)
  • Hypertension (catecholamine secretion or renal artery compression, among 1.3% of cases)
  • Transverse myelopathy (tumor spinal cord compression, among 5% of cases)
  • Anemia and decreased immunity (bone marrow metastasis)

Prognosis

  • Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis of neuroblastoma is generally regarded as poor.
  • The table below lists the prognostic factors for neuroblastoma patients:[1][2][3][4]
Prognostic Factor Description
Patients Age
Patients older than 18 months of age are associated with poor prognosis.
Tumor Stage
Advanced INSS stages of neuroblastoma are associated with poor prognosis.
Tumor Grade
An unfavorable Shimada histology index is associated with poor prognosis.
Schwannnian Stroma
A reduced schwannian stroma background content on histological analysis is associated with poor prognosis.
Mitotic-karyorrhectic Index
A high mitotic-karyorrhectic index is associated with poor prognosis.
Genetics Mutations
Chromosome 1p deletion, chromosome 11q deletion, and N-MYC oncogene amplification are associated with poor prognosis.
Response to Treatment
Patients whose neuroblastoma responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment.


References

  1. ↑ Neuroblastoma. Radiopaedia(2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 5 2015
  2. ↑ Neuroblastoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Neuroblastoma Accessed on October, 5 2015
  3. ↑ Neuroblastoma Treatment for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#link/_534_toc Accessed on October, 7 2015
  4. ↑ Neuroblastoma. Libre Pathology(2015) http://librepathology.org/wiki/index.php/Adrenal_gland#Neuroblastoma Accessed on October, 5 2015

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