NCLEX Review Guide: Pediatric Neuroblastoma

Disease Overview

• Neuroblastoma is the most common extracranial solid tumor in children, arising from neural crest cells of the sympathetic nervous system.
• Peak incidence occurs in children under 5 years old, with 90% of cases diagnosed before age 5.
• Most commonly originates in the adrenal medulla but can occur anywhere along the sympathetic chain.

Clinical Manifestations

• Abdominal mass is the most common presenting sign, often discovered during routine examination or by parents during bathing.
• Systemic symptoms include fever, weight loss, bone pain, and hypertension due to catecholamine release.
• Advanced disease may present with raccoon eyes (periorbital ecchymosis), bone marrow involvement causing anemia and thrombocytopenia.
• Horner's syndrome may occur if tumor compresses sympathetic nerves in the neck region.

Diagnostic Tests

• 24-hour urine collection for vanillylmandelic acid (VMA) and homovanillic acid (HVA) - elevated in 90% of cases.
• CT or MRI imaging to determine tumor location, size, and metastatic spread to liver, bone, or lymph nodes.
• MIBG scan (metaiodobenzylguanidine) helps identify primary tumor and metastases with high specificity.
• Bone marrow biopsy to assess for metastatic disease, especially important for staging.

Treatment Modalities

1. Surgical resection is the primary treatment for localized tumors when feasible.
2. Chemotherapy protocols typically include cyclophosphamide, doxorubicin, etoposide, and cisplatin.
3. High-risk patients may require high-dose chemotherapy with autologous stem cell transplant.
4. Radiation therapy is used for residual disease or as palliative care for bone metastases.

Nursing Interventions

• Monitor for tumor lysis syndrome during initial chemotherapy - watch for hyperkalemia, hyperphosphatemia, and acute kidney injury.
• Assess for signs of increased intracranial pressure if CNS metastases are present.
• Provide age-appropriate pain management using multimodal approaches including pharmacologic and non-pharmacologic methods.
• Monitor cardiac function closely due to doxorubicin cardiotoxicity - baseline and periodic ECHOs required.

Psychosocial Support

• Provide honest, age-appropriate information to child and family about diagnosis and treatment plan.
• Connect families with social services, child life specialists, and support groups for childhood cancer.
• Address siblings' needs and concerns, as they may feel neglected or fearful during treatment.

Self-Assessment Checklist

• ☐ Can I identify the classic presentation of neuroblastoma?
• ☐ Do I understand the staging system and prognosis?
• ☐ Can I explain the significance of catecholamine metabolites?
• ☐ Do I know the key nursing interventions during treatment?
• ☐ Can I differentiate neuroblastoma from other pediatric tumors?