A review and update on neuroblastoma

Neuroblastoma is an enigmatic disorder, being a pathological entity, but presenting clinically with a wide range of symptoms and responding to treatment in a plethora of different and sometimes unpredictable ways. This represents a challenge for those charged with diagnosing and treating the disease. It is a disease of young children, being the most common tumour in infants, with the prognosis worsening with increasing age at presentation. There are no particular risk factors, so the diagnosis depends on clinical examination and appropriate investigations. Once the diagnosis has been made, further staging investigations and risk stratification are undertaken prior to commencing treatment. Once identified, high-risk disease remains the greatest challenge, with many of these cases ultimately relapsing. Treatment is best undertaken within a specialist, multidisciplinary team, with many medical specialties and allied health professionals involved, in order to optimize the progress and outcome. With high-risk disease being so aggressive, so does the treatment need to be. There are new treatment modalities available which are associated with significant side and late effects. The challenge is how to bring these into the current treatment regimens in order to reduce the relapse rate without causing excessive harm.