Canadian Cancer Society logo

Neuroblastoma

You are here: 

Staging neuroblastoma

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes where the cancer is in the body. The child’s healthcare team uses the stage to plan treatment and estimate prognosis.

Doctors use 2 staging systems for neuroblastoma.

International Neuroblastoma Staging System

The most common staging system for neuroblastoma is the International Neuroblastoma Staging System (INSS). The INSS staging system is based on how much of the tumour is removed during surgery (called the degree of surgical resection). Each stage is given a number from 1 to 4. Generally, the higher the number, the more the cancer has progressed.

StageDescription

1

The tumour is localized, which means that it is only in the area where it started (called the original site). It can be completely removed by surgery.

The cancer has not spread to any lymph nodes.

2A

The tumour is only in the area where it started (called the original site), but it can’t be completely removed with surgery.

The cancer has not spread to any lymph nodes.

2B

The tumour is only in the area where it started (called the original site). It may or may not be completely removed with surgery.

The cancer has spread to lymph nodes on the same side of the body as the tumour (called ipsilateral lymph nodes), but not to lymph nodes on the opposite side of the body (called contralateral lymph nodes).

3

The tumour has grown across the midline (defined by the spinal column) to the other side of the body and cannot be completely removed by surgery. The cancer may have spread to lymph nodes near the tumour.

or

The tumour is only in one area on one side of the body, but cancer cells have spread to lymph nodes on the other side of the body.

or

The tumour has developed in the middle of the body (on the midline) and the cancer has spread to lymph nodes or tissues on both sides of the body. The cancer cannot be completely removed by surgery.

4

The cancer has spread to lymph nodes and other parts of the body farther from the tumour (called distant lymph nodes and distant sites). Distant sites can include the bone, bone marrow, liver, skin or other organs.

4S

This stage is used for children younger than 1 year old.

The tumour is only in one area of the body (as in stage 1 and 2). It may or may not be completely removed with surgery.

The cancer may or may not have spread to lymph nodes on the same side of the body as the tumour (called ipsilateral lymph nodes).

The cancer has only spread to the liver, skin or bone marrow but not to any bones. If it has spread to the bone marrow, less than 10% of the cells in the bone marrow are cancer cells.

International Neuroblastoma Risk Group Staging System

The International Neuroblastoma Risk Group Staging System (INRGSS) is based on imaging tests done before treatment rather than on how much cancer is removed during surgery.

StageDescription

L1

The tumour is only in the area where it started (called localized). It hasn’t grown into vital structures (the tumour lacks image defined risk factors) and it is confined to one body area, such as the neck, chest, abdomen or pelvis.

L2

The tumour is in 2 different areas of the body, often directly connected, but it has not spread to distant sites (parts of the body far from where the tumour started). For example, it may have grown from the left side of the chest into the left side of the abdomen.

Doctors can identify one or more risk factors with imaging tests, which may make the tumour more difficult to remove surgically. For example, the tumour has grown into vital structures such as the spine.

M

The cancer has spread to parts of the body farther from the original tumour (called distant metastatic disease).

MS

The child is younger than 18 months. The cancer has only spread to the skin, liver or bone marrow. If it has spread to the bone marrow, less than 10% of the cells in the bone marrow are cancer cells. MIBG scan does not show cancer in the bone or bone marrow.

Recurrent neuroblastoma

Recurrent neuroblastoma means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called distant recurrence.

Stories

Stephanie Hermsen Thanks to the incredible progress in retinoblastoma research made possible by Canadian Cancer Society funding, my son won’t have to go through what I did.

Read Stephanie's story

Access to services in your community

Illustration of houses side-by-side

The Canadian Cancer Society’s Community Services Locator helps cancer patients and their families find the services and programs they need in their community.

Learn more