the International Neuroblastoma Staging System (INSS)

INSS Stages
Stage 1: Tumor is confined to one area (localized) and can
be completely removed through surgery. Nearby lymph nodes
do not contain cancer cells.
Stage 2A: Tumor is localized and confined to one side of
the body but cannot be completely removed. Nearby lymph
nodes do not contain cancer cells.
Stage 2B: Tumor is localized and may or may not be
completely removed. Nearby lymph nodes show cancer cells.
Enlarged lymph nodes on the opposite side of the body do not
contain cancer cells.
Stage 3: Must meet one of these two criteria:
Tumor starts in or crosses the vertical midline of the
body (marked by the spine) and cannot be removed surgically.
Lymph nodes in the area may or may not contain cancer cells.
Tumor is restricted to one side of the body but there
are enlarged lymph nodes on the opposite side of the body that
contain cancer cells.
Stage 4: The primary tumor(s) has spread to distant lymph
nodes, bone, bone marrow, liver, skin and/or other organs.
Stage 4-S: The S stands for special. These tumors are
unique in that they often disappear on their own
(spontaneous regression) without any treatment. Must meet
special criteria:
Child must be less than 12 months old.
Localized primary tumor that has spread only to the
skin, lymph nodes or liver. Very small amounts of tumor may be
seen in the bone marrow, but the disease cannot involve the
outer portion of the bone (cortex).