Low-risk neuroblastoma: the decisions you may face
4 treatment settings, 4 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
L1 tumours and small adrenal masses in infants
Observation with serial ultrasound and urinary catecholamines, or surgical resection; no chemotherapy.
For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
- Avoids incontinence and erectile dysfunction of treatment in men who would never be harmed
- Level-1 evidence of safety (ProtecT)
Ultrasound uses sound waves to make live pictures; it is cheap, safe, and used to guide needles into lumps.
- Real-time, portable, no radiation
- Ideal biopsy guidance
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
- No ionising radiation
- Best soft-tissue and brain imaging
- Functional sequences (diffusion, perfusion)
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Anxiety and adherence
- Repeat biopsies
- Under-used outside high-income countries
- Operator dependent
- Cannot see through bone or air
- Slow and expensive
- Motion artefacts
- Gadolinium concerns in renal impairment
- Between Active surveillance, Ultrasound and MRI, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCI PDQ: Neuroblastoma Treatment (health professional version)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (l1 tumours and small adrenal masses in infants), which of the standard options do you recommend and why?Why: Guideline options include: Observation with serial ultrasound and urinary catecholamines, or surgical resection; no chemotherapy.
Add these to your appointment list, or take the full question set for this cancer.
L2 tumours in infants with favourable biology
Expectant observation or surgery; short carboplatin and etoposide or cyclophosphamide only for symptoms or threat to organs.
For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
- Avoids incontinence and erectile dysfunction of treatment in men who would never be harmed
- Level-1 evidence of safety (ProtecT)
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.
Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Anxiety and adherence
- Repeat biopsies
- Under-used outside high-income countries
- Dose by Calvert formula using GFR (see the calculators).
- Reduce to 75% for CrCl 15-50.
- Between Active surveillance, Carboplatin, Etoposide and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCI PDQ: Neuroblastoma Treatment (health professional version)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (l2 tumours in infants with favourable biology), which of the standard options do you recommend and why?Why: Guideline options include: Expectant observation or surgery; short carboplatin and etoposide or cyclophosphamide only for symptoms or threat to organs.
- Am I a candidate for Carboplatin, Etoposide, Cyclophosphamide, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Stage MS
Observation; carboplatin and etoposide or low-dose cyclophosphamide for a rapidly enlarging liver or respiratory compromise.
For low-risk prostate cancer, monitoring with PSA, MRI, and repeat biopsy instead of treating, because most such cancers never cause harm.
- Avoids incontinence and erectile dysfunction of treatment in men who would never be harmed
- Level-1 evidence of safety (ProtecT)
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.
Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.
Ultrasound uses sound waves to make live pictures; it is cheap, safe, and used to guide needles into lumps.
- Real-time, portable, no radiation
- Ideal biopsy guidance
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Anxiety and adherence
- Repeat biopsies
- Under-used outside high-income countries
- Dose by Calvert formula using GFR (see the calculators).
- Reduce to 75% for CrCl 15-50.
- Operator dependent
- Cannot see through bone or air
- Between Active surveillance, Carboplatin, Etoposide and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCI PDQ: Neuroblastoma Treatment (health professional version)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (stage ms), which of the standard options do you recommend and why?Why: Guideline options include: Observation; carboplatin and etoposide or low-dose cyclophosphamide for a rapidly enlarging liver or respiratory compromise.
- Am I a candidate for Carboplatin, Etoposide, Cyclophosphamide, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Follow-up
Ultrasound and urinary catecholamines, tapering over years; late-effects follow-up for the few who received chemotherapy.
Ultrasound uses sound waves to make live pictures; it is cheap, safe, and used to guide needles into lumps.
- Real-time, portable, no radiation
- Ideal biopsy guidance
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
- No ionising radiation
- Best soft-tissue and brain imaging
- Functional sequences (diffusion, perfusion)
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Operator dependent
- Cannot see through bone or air
- Slow and expensive
- Motion artefacts
- Gadolinium concerns in renal impairment
- Between Ultrasound and MRI, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCI PDQ: Neuroblastoma Treatment (health professional version)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (follow-up), which of the standard options do you recommend and why?Why: Guideline options include: Ultrasound and urinary catecholamines, tapering over years; late-effects follow-up for the few who received chemotherapy.
Add these to your appointment list, or take the full question set for this cancer.