Neuroblastoma in the very young child: biological considerations

Neuroblastoma is one of the childhood malignancies that frustrates both the clinical and scientist. Clearly, some forms of the disease are relatively benign and the patient can expect to be cured. However, even today, Stage 4 neuroblastoma is one of the childhood malignancies where the overall prognosis remains very poor. Despite extensive investigations into the biology of the disease, little has been gleaned about the underlying causes of the tumour and what truly separates good and poor risk disease. Fortunately, patients under the age of one with neuroblastoma often fall into the good risk group. Many people now believe that neuroblastoma is not just one disease, but several. Some forms of the tumours may, in fact, not be truly malignant. The data that has led to this conclusion and the biological characteristics that are associated with the different forms of the neuroblastoma will be reviewed. In addition, a brief outline of new studies which may identify some of the factors associated with the neuroblasts ability to metastasise will be discussed.