Pediatric Nursing Demystified

Neuroblastoma

Neuroblastomasare the most common abdominal tumor in childhood. The

tumors arise from greatly undifferentiated and invasive cells from the sympa-

thetic nervous system. Tumors usually occur in the abdomen near the adrenal

gland or spinal ganglia but may also be noted in the head, neck, chest, or

pelvis. Neuroblastomas occur primarily in infants <2 years of age (50%) and

preschool children (25%) and slightly more often in males than females.

Metastasis is most commonly to the bone marrow, liver, and subcutaneous

tissue.

Signs and Symptoms

Common assessment findings:

• Symptoms depend on the location and stage of the tumor (secondary
  to pressure on adjacent structures—respiratory distress from thoracic
  mass).


• Cervical or supraclavicular lymphadenopathy may be noted.


• Presents as a firm, irregular, painless mass in the abdomen that
  crosses the midline.


• Urinary retention or frequency may be noted if kidney is compressed.


• Periorbital edema, exophthalmos, and supraorbital ecchymosis are
  noted with metastasis to the retrobulbar tissue.


• Weight loss and anorexia may be noted due to tumor pressure.


• Difficulty swallowing and edema of the neck and face may occur
  from compression on the vena cava.


• Jaundice from liver pressure may be noted and if metastasis to the skin
  has occurred, blue or purplish nodules may be noted on the arms or legs.


• Flushed face, excessive sweating, and hypertension may result from
  adrenal pressure.


• Symptoms of neurologic impairment, including paralysis from com-
  pressed nerves, may be noted, as well as neurologic changes from
  intracranial lesions.

Test Results

Diagnosis by biopsy.

Skeletal survey of skull, chest, abdomen, and bone marrow aspirates.

Blood count, urinalysis (may reveal catecholamine excretion from

adrenals).

CT scan and bone scans to detect metastasis.

Vanillylmandelic acid (VMA), homovanillic acid (HVA), dopamine in

urine (breakdown products of catecholamines) may be noted with an

adrenal tumor.

Increased ferritin, neuron-specific enolase (NSE), and ganglioside(GD2)

may be noted (isoenzymes from neurons).

(^166) Pediatric Nursing Demystified