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Your child' s doctor selects a treatment plan based on several factors that affect your child' s prognosis. Factors include your child' s age, the stage of the cancer, the type of cells involved in the cancer, and whether there are any abnormalities in the chromosomes and genes. Using this information, your child' s doctor categorizes the cancer as low risk, intermediate risk or high risk. What treatment or combination of treatments your child receives for neuroblastoma depends on the risk category.

Surgery Surgeons use scalpels and other surgical tools to remove cancer cells. In children with low- risk neuroblastoma, surgery to remove the tumor may be the only treatment needed.

Whether the tumor can be completely removed depends on its location and its size. Tumors that are attached to nearby vital organs & mdash; such as the lungs or the spinal cord & mdash; may be too risky to remove. In intermediate- risk and high- risk neuroblastoma, surgeons may try to remove as much of the tumor as possible. Other treatments, such as chemotherapy and radiation, may then be used to kill remaining cancer cells.

Chemotherapy Chemotherapy uses chemicals to destroy cancer cells. Chemotherapy targets rapidly growing cells in the body, including cancer cells.

Unfortunately, chemotherapy also damages healthy cells that grow quickly, such as cells in the hair follicles and in the gastrointestinal system, which can cause side effects. Children with low- risk neuroblastoma that can' t be removed surgically may undergo chemotherapy. Sometimes chemotherapy is administered before surgery ( neoadjuvant chemotherapy) to shrink the tumor to a size that' s more easily removed. In other cases, chemotherapy may be the only treatment. Children with intermediate- risk neuroblastoma often receive a combination of chemotherapy drugs before surgery to improve the chances that the entire tumor can be removed.

Children with high- risk neuroblastoma usually receive high doses of chemotherapy drugs to shrink the tumor and to kill any cancer cells that have spread elsewhere in the body. Chemotherapy is usually used before surgery and before bone marrow stem cell transplant. Radiation therapy Radiation therapy uses high doses of energy particles to destroy cancer cells.

Radiation therapy primarily affects the area where it' s aimed. Your child' s radiation therapy team tries to protect the healthy cells near the cancer, but some healthy cells may be damaged by the radiation.

What side effects your child experiences depends on where the radiation is directed and how much radiation is administered. Children with low- risk or intermediate- risk neuroblastoma may receive radiation therapy if surgery and chemotherapy haven' t been helpful. Children with high- risk neuroblastoma may receive radiation therapy after chemotherapy and surgery, to prevent cancer from recurring.

Stem cell transplant Children with high- risk neuroblastoma may receive a transplant using their own blood stem cells ( autologous stem cell transplant) . The bone marrow produces stem cells, which mature and develop into the red and white cells and platelets that make up the blood.

Your child undergoes a procedure that filters and collects stem cells from his or her blood. Then high doses of chemotherapy are used to kill any remaining cancer cells in your child' s body. Your child' s stem cells are then injected into your child' s body, where they can form new, healthy blood cells. Long- term and late side effects of cancer treatment As more and more children are surviving cancer and living into adulthood, doctors are increasingly aware of the long- term side effects of cancer treatment. Doctors recommend childhood cancer survivors be seen regularly by a doctor who understands the long- term and late side effects that can affect children after cancer treatment.

Side effects vary depending on treatment, but may include impaired growth, thyroid problems, second cancers and infertility, which may be caused by chemotherapy drugs. Difficulty thinking and trouble processing thoughts may be long- term side effects of radiation, especially brain radiation or total body irradiation. & copy; 1998- 2011 Mayo Foundation for Medical Education and Research ( MFMER) .

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