How quickly should my child start treatment after diagnosis?

The timing of treatment depends on your child’s risk group and individual clinical needs. Your child will be assessed using several factors including age, tumour location, stage, and tumour biology. These factors help determine how urgent treatment needs to be. 

Understanding why timing varies

After diagnosis, your child’s medical team will carry out tests to classify the neuroblastoma into risk group (low, intermediate, or high risk). This classification helps the team decide what treatment is needed and how quickly it needs to start.

Read more about the different risk groups for neuroblastoma.

Low‑risk disease

For some children, especiallybabies and very young children with low‑risk disease, treatment may not need to start immediately. In certain cases, the safest approach is active monitoring, where the tumour is watched closely to see if it shrinks or disappears without treatment. 

This approach is common for small tumours that are not causing symptoms and have features suggesting they may resolve naturally.

Read more about the treatment for low-risk neuroblastoma.

Intermediate‑risk disease

Children with intermediate‑risk neuroblastoma fall between low‑risk and high‑risk disease. Some children in this group can safely wait short time before starting treatment, while others need to begin sooner depending on symptoms, tumour size and tumour biology.

Treatment may begin once: 

• all tests and scans have been completed 

• the tumour biology has been reviewed 

• the multidisciplinary team has agreed the safest plan 

• any symptoms are being appropriately managed 

Some children with intermediate‑risk disease may begin treatment sooner, for example, if: 

• the tumour is causing discomfort or affecting organs 

• the tumour is larger 

• the biology suggests the tumour is unlikely to regress without treatment 

Others may have a short period of monitoring while clinicians gather all necessary information. 

This is normal, intermediate‑risk neuroblastoma is a broad category, and timing varies depending on the exact tumour features. 

Read more about the treatment for intermediate-risk neuroblastoma.

High‑risk disease

For children diagnosed with high‑risk neuroblastoma, treatment usually begins as soon as it is safe to do so. This is because high‑risk disease tends to grow and spread more quickly.

Treatment typically begins in a Primary Treatment Centre, and may start as soon as: 

• initial tests and scans are complete 

• a treatment plan has been agreed 

• a hospital bed becomes available 

High‑risk treatment usually includes multiple stages (such as induction chemotherapy, surgery, high‑dose-chemotherapy, radiotherapy and immunotherapy).

Read more about the treatment for high‑risk neuroblastoma.

What to expect while waiting to start treatment

Even if treatment does not start immediately, your child will be closely monitored. Your consultant will only delay treatment when it is medically safe to do so. During this time, the team may:

• carry out further tests

• repeat imaging

• review tumour biology 

• finalise the safest and most appropriate treatment plan 

You can always ask your child’s consultant to explain the planned timeline and why it is appropriate for your child.