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Neuroblastoma Treatment (PDQ®): Treatment - Patient Information [NCI] - Stages of Neuroblastoma

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Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if neuroblastoma spreads to the liver, the cancer cells in the liver are actually neuroblastoma cells. The disease is metastatic neuroblastoma, not liver cancer.

The following stages are used for neuroblastoma:

Stage 1

In stage 1, the tumor is in only one area and all of the tumor that can be seen is completely removed during surgery.

Stage 2

Stage 2 is divided into stages 2A and 2B.

  • Stage 2A: The tumor is in only one area and all of the tumor that can be seen cannot be completely removed during surgery.
  • Stage 2B: The tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery. Cancer cells are found in the lymph nodes near the tumor.

Stage 3

In stage 3, one of the following is true:

  • the tumor cannot be completely removed during surgery and has spread from one side of the body to the other side and may also have spread to nearby lymph nodes; or
  • the tumor is in only one area, on one side of the body, but has spread to lymph nodes on the other side of the body; or
  • the tumor is in the middle of the body and has spread to tissues or lymph nodes on both sides of the body, and the tumor cannot be removed by surgery.

Stage 4

Stage 4 is divided into stages 4 and 4S.

  • In stage 4, the tumor has spread to distant lymph nodes or other parts of the body.
  • In stage 4S:
    • the child is younger than 12 months; and
    • the cancer has spread to the skin, liver, and/or bone marrow; and
    • the tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery; and/or
    • cancer cells may be found in the lymph nodes near the tumor.
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