الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Neuroblastoma originates from tissues of neural crest ongm, namely the adrenal medulla and the sympathetic nervous system. It is a complex disease with a wide variety of symptoms due to the numerous possible sites for the primary tumor and the wide spread pattern for metastases. The patient may also present with symptoms referable to catecholamine production; flushing, headache, and tachycardia.
The primary tumor should be assessed with CT or MRI. Bone scan and MIBG scan should also be performed to examine bone metastases. Lab investigations should include CBC to detect bone marrow invasion and consequent bone marrow depression, serum ferritin level, and neuron-specific enolase (NSE), the latter two are considered valuable prognostic factors as well as diagnostic.
Based on age, N-myc amplification, histopathology, DNA index (DI), and telomerase expression, neuroblastoma is divided into low-, intermediate-, and high-risk disease. The now widely accepted approach to treating neuroblastoma is risk-related therapy. Not all factors may necessarily be available, but therapy should be based on as much data as possible.
Excellent prognosis (survival 85-95%) can be achieved when treating low-risk disease with surgery alone. However, there are a few cases such as massive hepatic enlargement compromising respiration in stage 4-s or spinal cord compression when additional radiotherapy or chemotherapy may be needed.
Intermediate-risk patients have a greater than 80% chance· of long-term survival with conventional chemotherapy, surgery and if necessary local radiotherapy. Current regimens include surgery and chemotherapy with the most active drugs against neuroblastoma such as cyclophosphamide, doxorubicin,