Surgery for neuroblastoma

Most children with neuroblastoma will have surgery. The type of surgery your child will have depends mainly on the location of the tumour, if it can be removed (if it is resectable) and if the cancer has spread. When planning surgery, the healthcare team will also consider your child's age and risk group.

Surgery may be done for different reasons. Your child may have surgery to:

• take a biopsy and confirm the diagnosis of neuroblastoma
• get a sample of the tumour for cell and tissue studies to determine certain prognostic factors, such as tumour histology
• stage the disease, which usually includes removing some nearby lymph nodes to see if they contain any cancer
• remove as much of the tumour as possible
• remove any cancer that is left after chemotherapy (called residual disease)
• check how the cancer is responding to treatment after several courses of chemotherapy (called second-look surgery)
• relieve symptoms caused by spinal cord compression

The following types of surgery are used to treat neuroblastoma. Your child may also have other treatments before or after surgery.

The surgeon may do an excisional biopsy, which removes all or most of the tumour. For low-risk disease, excisional biopsy may be the only treatment needed. If the surgeon can successfully remove all of the tumour during the excisional biopsy, it is called a complete resection.

In some cases, doctors may do an incisional biopsy to remove part of the tumour. They use incisional biopsy if they can’t remove all of the tumour safely because it is touching or next to vital structures.

Find out more about surgical biopsy.

Lymph node dissection is surgery to remove lymph nodes that may contain cancer. This procedure is used to stage and treat neuroblastoma. The type of lymph node dissection done depends on the location of the primary tumour.

Find out more about lymph node dissection.

When doctors can’t remove all of the tumour during the surgical biopsy, chemotherapy is given as the main treatment. Second-look surgery is done after chemotherapy to see how well the treatment has worked. If there is any remaining tumour, the surgeon may be able to remove it during second-look surgery.

Laminectomy is surgery to remove part of the bone covering the spinal canal (the cavity created by the vertebrae that contains the spinal cord). It is used to relieve symptoms caused by a tumour pressing on the spinal cord (called spinal cord compression). Laminectomy is usually only used to treat spinal cord compression if it can't be relieved with chemotherapy or radiation therapy.

Side effects can happen with any type of treatment for neuroblastoma, but everyone's experience is different. Some children have many side effects. Other children have only a few side effects.

Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery, the size and location of the tumour, and your child's age and overall health. General side effects include:

• pain
• nausea and vomiting
• infection
• bleeding

Tell the healthcare team if your child has these side effects or others you think might be from surgery. The sooner they are aware of any problems, the sooner they can suggest ways to help your child deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for your child, ask the healthcare team questions about surgery.