First Fight Last fight? 

What if you were told your child has cancer? What if you were told there was no cure... In this week’s post, we look at one of many cancers that affects children and infants across the country, leaving them fighting a battle with little or no known knowledge of why they are experiencing something so awful or how long they will remaining fighting for.

Neuroblastoma is a rare type of cancer most commonly found in babies and young children under the age of five. The initial cause of the disease is unknown, but it is understood that it is related to body signalling that causes cells to grow from primitive baby cells to more mature adult cells, and the defect in the control of such signalling that causes these primitive cells to mature into malignant tumours. 

It develops when neuroblasts which mature into neurons (nerve cells), continue to mature causing a tumour to begin, hence the word "Neuro" means nerve and "blast" means cells in early development. Add an "oma”, meaning “group of cells" or "tumour" onto it and we get a malignant cancerous cell which causes children from ages as young as 6 months to 5 years old left with concern and doubt for why they must undergo treatments such as Surgery to High Dose Chemotherapy followed by stem cell transplant, Radiotherapy, Immunotherapy, and Retinoid therapy. 

Symptoms and diagnosis 

This condition as discussed earlier happens in children till the age of 5, and very rarely at later ages. It is commonly diagnosed within the abdomen on the adrenal glands located above the kidneys, or along the nerves the run along the spinal cord in the neck, chest, tummy, or pelvis. Furthermore, this is a type of metastasis cancer that spreads to other organs such as the bone marrow, bone, lymph nodes, liver, and skin.  The symptoms are minute and parents rarely capable of identify them till late after the condition has begun, e.g. when bathing their child and finding a lump on their abdomen; causing the child discomfort pain and swelling.  In addition, being a type of metastasis cancer and spreading throughout the body, other symptoms are those such as numbness weakness loss of movement in lower part of the body - due to condition effecting the spinal cord, breathlessness and difficulty swallowing- associated with a lump in the neck.  Parents may originally think there child has a flu, as the symptoms are normally associated with tiredness within everyday life and usually common and not an issue of concern. 


Tests for Diagnosis 


Urine Test - To test for chemicals produced by neuroblastoma cell in the urine - HMA (homovanilic acid) and VMA (vanillylmandelic acid) which are waste products of catecholamines (organic molecule made up of an organic compound that has a catechol and a side-chain amine- e.g. epinephrine(adrenaline), nor epinephrine and dopamine) which act as neurotransmitters as well as hormones that regulate physiological functions(heartbeat and breathing rate). 

MIGB scan-  doctors attach a small amount of radioactive iodine to MIGB injecting it into the
bloodstream. If nueroblasts pick up the MIGB and then the radioactive iodine it shows up on
the scan. 

Biopsy - examination of tissue removed from the living body to examine the presence of a type of
disease. In relation to cancer - the removal of a tissue from the suspected cancer cell to
examine under microscope to identify the type of cancer cell 

Bone marrow Biopsy - to see is cancer cells are in the bone marrow 

Scans Including: X-Ray of chest, CT Scan(computed tomography), MRI Scan, more commonly, before birth - Ultrasound scans. 

After diagnosis has confirmed and issue identified and neuroblastoma, it is possible to determine the stage of the cancer in order to proceed with the most efficient and appropriate  treatment.  The staging system is as follows : 

Stage 1/2.  L1 - Cancer is just at one place, has not metastasised- not spread and can be removed

                  safely surgical via operation . 

Stage 3.     L2-  Cancer hasn't spread, at one place but cannot be surgically removed by operation

Stage 4.     M- The cancer has metastasised and spread to other parts of the body

Stage 5.     Ms - Special case. Stage same as Stage 4 and the cancer has spread to the skin, liver and                       bone marrow - but the child diagnosed is less then 18 months old 

Babies and infants in L1 and MS who are under 18 months of age it is possible that the cancer can sometimes go away on its own, and doctors suggest a process known as "waitful watching" where you wait before treatment to allow time for the cancer to go away on its own, and save patient from proceeding onto treatment . 

Treatments for neuroblastoma are:   

1. Surgery-  L1 to remove the tumour

2. Chemotherapy - where medication is used to kill the cancer cells

3. Radiotherapy - where radiation is used to kill cancer cells 

4. High dose chemotherapy followed by stem cell transplant-where stem cells are collected and frozen prior to High dose Chemotherapy and given back to patient post therapy. 

5. Immunotherapy- medication that directly targets neuroblastoma cells are given 

                                                              

Bradley led England out at Wembley last month for the World Cup qualifying game against Lithuania
Bradly Lowery - leading out
               England last month

Cancer, a word many dread to hear, but when you are young, innocent and finding joy in the simplest of discovery's within a tiny world , this word can change your life before you even began to live it. This was the case Bradley Lowery when on January 7th 2013 at the age of two he was diagnosed with nueroblastoma above his left kidney. The young tiny 5 year old underwent many does of Chemo with antibody to destroy his cancer cells. His mother reported to the news on 5th April 2017, that there is no evidence his treatment has worked but they are waiting to see the results. This 6 year old has now been selected for new immunotherpay trial. This is just one of the hundred cases of neuroblastoma diagnosed in the UK every year, meanwhile America having a more devastating diagnosis scale of 600 children every year.  This could have happened to any one of us, you, me, your brother/sister, son/daughter, any young child eagerly waiting  to explore the wonders of the world throughout their lives. But cancer is in their ways, preventing their dreams lives, and footsteps from going further and moving ahead.  It is important for us to fight this disease together, and overcome such trials through care and compassion towards others. One way in which you can do this through donating. One act, could prosper many lives in the future, and bring breakouts in research. 

For you to donate, visit the following links: 


Hope you have found this insightful, Mathew George (Universal Medicine team) 

Sources 

http://www.nhs.uk/conditions/neuroblastoma/Pages/Introduction.aspx

http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/neuroblastoma

http://www.childrenwithcancer.org.uk/neuroblastoma

https://www.thesun.co.uk/news/3258770/bradley-lowery-mum-new-treatment-neuroblastoma/

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