Localized resectable
• cancer is confined to the site of origin with NO evidence of spread
• cancer can be surgically removed
Localized unresectable
• cancer is confined to the site of origin
• BUT the cancer cannot be completely removed surgically
Regional
• cancer has extended beyond the site of origin to regional lymph nodes and/or surrounding organs or tissues, but has not spread to distant parts
Disseminated
• cancer has spread from the site of origin to distant lymph nodes, bone, liver, skin, bone marrow, and/or other organs (except as defined for stage 4S)
Stage 4S
• stage 4S neuroblastoma is also called "special" neuroblastoma because it is treated differently. The cancer is localized, with spread limited to liver, skin, and/or, to a very limited extent, bone marrow
Recurrent
• recurrent neuroblastoma means that the cancer has come back (recurred) or continued to spread (progressed) after it was treated. It may come back in the original site or in another part of the body.
The actual medical staging system used by healthcare professionals is The International Neuroblastoma Staging System (INSS), which has been in use since the 1990's. The stages are:
Stage 1
The cancer is on one side of the body and is localized (hasn't spread). All visible tumor is totally removed by surgery. Examination of the tumor's edges under the microscope may show some cancer cells. Lymph nodes enclosed within the tumor may contain neuroblastoma cells, but lymph nodes outside of the tumor should be free of cancer.
Stage 2A
The cancer is on one side of the body and is localized, but because of its size, location, or relationship to other organs, it cannot be totally removed by surgery.Lymph nodes enclosed within the tumor may contain neuroblastoma cells, but lymph nodes outside of the tumor should be free of cancer.
Stage 2B
The cancer is on one side of the body, is localized, and may or may not be able to be totally removed by surgery.Lymph nodes outside the tumor contain neuroblastoma cells, but the cancer has not spread to lymph nodes on the other side of the body.
Stage 3
• The cancer cannot be completely removed by surgery.
• It has crossed the midline to the other side of the body. It may or may not have spread to nearby lymph nodes. OR
• It is on one side of the body but has spread to lymph nodes that are relatively nearby but on the other side of the body. OR
• It is in the middle of the body and growing toward both sides and cannot be completely removed by surgery.
Stage 4
The cancer has spread to distant sites such as lymph nodes, bone, liver, skin, bone marrow, or other organs. But the child does not meet criteria for stage 4S.
Stage 4S (also called "special" neuroblastoma)
The child is less than 1 year old. The cancer is on one side of the body and is localized. It may have spread to lymph nodes on the same side of the body, but not to nodes on the other side. Neuroblastoma has spread to the liver, skin, and/or the bone marrow. However, no greater than 10% of marrow cells may be cancerous, and imaging studies should not show bone damage.
