Key Points
                    - After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body.     - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - The following stages are used for neuroblastoma:         - Stage 1     - Stage 2     - Stage 3     - Stage 4        - Treatment of neuroblastoma is based on risk groups.
                
                
                    After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body.
                    The process used to find out the extent or spread of cancer is called staging. The information gathered from the staging process helps determine the stage of the disease. For neuroblastoma, the stage of disease affects whether the cancer is low risk, intermediate risk, or high risk. It also affects the treatment plan. The results of some tests and procedures used to diagnose neuroblastoma may be used for staging. See the General Information section for a description of these tests and procedures.   The following tests and procedures also may be used to determine the stage:         -   Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:                -  Excisional biopsy : The removal of an entire lymph node.      -  Incisional biopsy : The removal of part of a lymph node.      -  Core biopsy : The removal of tissue from a lymph node using a wide needle.       -  Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid from a lymph node using a thin needle.              -   X-ray of the bone: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.    -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
                
                
                    There are three ways that cancer spreads in the body.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
                
                
                    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.
                
                
                    Treatment of neuroblastoma is based on risk groups.
                    For many types of cancer, stages are used to plan treatment. For neuroblastoma, treatment depends on risk groups. The stage of neuroblastoma is one factor used to determine risk group. Other factors are the age of the child, tumor histology, and tumor biology.   There are three risk groups: low risk, intermediate risk, and high risk.         - Low-risk and intermediate-risk neuroblastoma have a good chance of being cured.    - High-risk neuroblastoma may be hard to cure.