Neuroblastoma is an extra-cranial tumor that is commonly found in children. It accounts for 8-10% of all childhood tumors and is associated with 15% cancer-related deaths in children. Approximately 90% of the tumors are diagnosed before the age of 5 years and in rare instances, the tumors are found in adolescence and adulthood.
Neuroblastomas are more common in males than in females. Neuroblastomas are either sporadic or have a family history (1-2% cases) in which case the inheritance pattern is autosomal dominant.(1)
Exercises And Activities For Neuroblastoma Patients
Advances in treatment have led to an increase in the number of cancer survivors. However, childhood cancers are associated with a lot of late effects, such as impaired growth and development, cognition, neurological function, musculoskeletal, cardiopulmonary function, and secondary tumors. Children also experience impaired physical fitness owing to chemotherapy, radiation therapy, and surgical intervention. It includes decreased muscle strength and cardiopulmonary function, fatigue, and altered physical function. Incorporating exercises soon after treatment can improve cardiopulmonary and musculoskeletal function and increase the opportunities for participating in recreational activities.(2)
The exercises should be supervised and include aerobic training, resistance, flexibility exercises, stretching and strengthening, community-based programs, and home-based exercises should be incorporated in the physical fitness regimen of cancer survivors that differ in intensity, timing and duration depending on the needs of each patient.
These exercise-based programs have positive implication for cardiopulmonary function, musculoskeletal and immunological health. Exercises and physical activities help in reducing cancer-related fatigue and increasing endurance. Overall, these exercises improve physical functioning and mobility along with positive effect in improving the quality of life of cancer survivors. There are no deleterious effects of exercise training on the overall health of the patient.(2)
Signs And Symptoms Of Neuroblastoma
The signs and symptoms of neuroblastoma depend widely on the location of the tumor, size, degree of invasion, effects from catecholamine secretion, and symptoms due to paraneoplastic syndromes. Approximately 65% tumors occur in abdomen (50% found in the medulla of the adrenal gland), 20% in the chest area, 5% in the neck area, 5% in the pelvis, and 1% of the tumors have undetected primary location.(1)
While some of the patients are asymptomatic, those who have symptoms present with malaise, fever, weight loss, pain, an enlarging mass, abdominal distension, lymphadenopathy, or respiratory distress due to compression by the tumor or hepatic enlargement. Tumors in the pelvic region can cause constipation or urinary difficulties, whereas, tumors in the chest area can lead to dysphagia, dyspnea or in rare occasions thoracic outlet syndrome. Patients with neck involvement may present with Horner’s syndrome and in 15% cases, the tumor has an epidural extension that may cause neurological comorbidities, such as progressive paralysis.(1)
The secretion of catecholamines in neuroblastomas can lead to early-onset hypertension and tachycardia. Metastasis is common in neuroblastomas and at the time of diagnosis, 35% of the patients have regional lymph node involvement. Metastasis to orbit is common leading to periorbital swelling and proptosis, skin involvement leads to blue colored subcutaneous nodules (blueberry muffin syndrome) and other metastatic sites include bone marrow, liver, and bone.(1)
Neuroblastoma Diagnosis And Treatment
The clinical presentation along with initial laboratory testing, such as complete blood count, serum electrolytes, liver function tests, chest radiograph, urine or serum catecholamines may show abnormalities. Imaging such as CT scan (neck, chest, abdomen), ultrasound, MRI, iodine-metaiodobenzylguanidine (MIBG) scan, and fluorodeoxyglucose positive emission tomography (FDG-PET) can be utilized for the detection of primary or secondary tumors. The confirmation of neuroblastoma can only be done by biopsy from a specimen obtained from a tumor or bone marrow.(1)
Like any other cancer, neuroblastoma is either treated with chemotherapy (cyclophosphamide, doxorubicin, cisplatin, melphalan, etoposide, vincristine), surgical resection, and/or radiotherapy. The relapse rate of aggressive neuroblastomas is as high as 50-60% with chemotherapeutic agents. The five-year survival rates have improved in the last 30 years rising from 52% to 74%.(1)