Risk groups and stages of neuroblastoma Risk groups If a child is diagnosed with neuroblastoma, they will be given a risk group, which mostly relates to their risk of the cancer coming back and how far it has spread. It also determines the treatment they will receive. There are three risk groups: Low-risk neuroblastoma Intermediate-risk neuroblastoma High-risk neuroblastoma Stages of neuroblastoma Like all cancers neuroblastoma can spread to other parts of the body. The most common areas include the liver, skin, and bones. There are different 'stages' of the disease which describe how far it has grown and spread, and clinicians use this staging to decide the best treatment paths for the child. Stage 1 Tumour is localised and has not spread. It can be almost completely removed by surgery. Stage 2 The tumour is localised and has not spread but it cannot be completely removed by surgery. This is often due to the position of the tumour meaning total tumour removal would cause damage to organs or major blood vessels. Stage 3 The tumour has begun to spread to nearby lymph nodes but not distant parts of the body. Stage 4 This is when the tumour has spread to distant parts of the body. This stage is usually designated as 'high-risk' and will usually be treated with chemotherapy, surgery, radiation, stem-cell transplant and immunotherapy. Relapse in this risk group is common. Stage 4s This is a stage unique to this type of childhood cancer and doesn't occur in children over 18 months old. It refers to a type of the disease that presents as a primary tumour and may have spread to local lymph nodes, but only on one side of the body. There will be no spread to the bones and less than 10% of bone marrow cells will be neuroblastoma. This type of disease has been known to spontaneously regress into a benign state and so often the only course of action will be to maintain close observation of the child to ensure nothing changes.