Signs and Symptoms of Neuroblastoma

Neuroblastoma can start in different places in the body. Neuroblastoma cells can also sometimes release chemicals called hormones, which can affect other parts of the body. Because of this, neuroblastoma can cause many different signs and symptoms. Some of the more common symptoms can include:

• Lump or swelling in the child's belly that doesn't seem to hurt
• Swelling in the legs or in the upper chest, neck, and face
• Problems with breathing or swallowing
• Weight loss
• Not eating or complaining about feeling full
• Problems with bowel movements or urinating
• Pain in bones
• Lumps or bumps under the skin, which may appear blue
• Drooping eyelid and small pupil (the black area in the center of the eye) in one eye
• Problems being able to feel or move parts of the body
• Eyes that appear to bulge and/or bruising around the eyes

Signs and symptoms might be different depending on where the tumor is, how large it is, how far it has spread, and if the tumor makes hormones.

Many of these signs and symptoms are more likely to be caused by something other than neuroblastoma. Still, if your child has any of these symptoms, check with your doctor so the cause can be found and treated, if needed.

Signs or symptoms caused by the main tumor

Tumors in the abdomen (belly) or pelvis: One of the most common signs of a neuroblastoma is a large lump or swelling in the child’s abdomen. The child might not want to eat (which can lead to weight loss). If the child is old enough, they may complain of feeling full or having belly pain. But the lump itself is usually not painful to the touch.

Sometimes, a tumor in the abdomen or pelvis can affect other parts of the body. For example, tumors that press against or grow into the blood and lymph vessels in the abdomen or pelvis can stop fluids from getting back to the heart. This can sometimes lead to swelling in the legs and, in boys, the scrotum.

In some cases, the pressure from a growing tumor can affect the child’s bladder or bowel, which can cause problems urinating or having bowel movements.

Tumors in the chest or neck: Tumors in the neck can often be seen or felt as a hard, painless lump.

If the tumor is in the chest, it might press on the superior vena cava (the large vein in the chest that returns blood from the head and neck to the heart). This can cause swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color). It can also cause headaches, dizziness, and a change in consciousness if it affects the brain.

Tumors in the chest or neck might also press on the throat or windpipe, which can cause coughing and trouble breathing or swallowing.

Neuroblastomas that press on certain nerves in the chest or neck can sometimes cause other symptoms, such as a drooping eyelid and a small pupil (the black area in the center of the eye), part of a condition known as Horner syndrome.

Pressure on other nerves near the spine might affect the child’s ability to feel or move their arms or legs.

Signs or symptoms caused by cancer spread to other parts of the body

Many neuroblastomas have already spread to the lymph nodes or other parts of the body by the time they are found.

Spread to the lymph nodes: Lymph nodes are bean-sized collections of immune cells found throughout the body. Cancer that has spread to the lymph nodes can cause them to swell. These nodes can sometimes be felt as lumps under the skin, especially in the neck, above the collarbone, under the arm, or in the groin. Enlarged lymph nodes in children are much more likely to be a sign of infection than cancer, but they should be checked by a doctor.

Spread to bones: Neuroblastoma often spreads to bones. A child who can talk may complain of bone pain. The pain may be so bad that the child limps or refuses to walk. If it spreads to the bones in the spine, tumors can press on the spinal cord and cause weakness, numbness, or paralysis in the arms or legs.

Spread to the bones around the eyes is common and can lead to bruising around the eyes or cause an eyeball to stick out slightly. The cancer might also spread to other bones in the skull, causing bumps under the scalp.

Spread to bone marrow: If the cancer spreads to the bone marrow (the inner part of certain bones, where new blood cells are made), the child may not have enough red blood cells, white blood cells, or blood platelets. These shortages of blood cells can result in tiredness, irritability, weakness, frequent infections, and excess bruising or bleeding from small cuts or scrapes.

Bleeding problems: Rarely, large tumors can start to break down, leading to a loss of clotting factors in the blood. This can result in a high risk of serious bleeding, which is known as a consumption coagulopathy and can be life threatening.

Stage 4S (MS) neuroblastoma: A special widespread form of neuroblastoma (known as stage 4S or stage MS) sometimes occurs, usually during the first few months of life. In this special form, the neuroblastoma has spread to the liver, to the skin, and/or to the bone marrow (in small amounts). Blue or purple bumps that look like small blueberries may be a sign of spread to the skin. The liver can become very large and can be felt as a mass on the right side of the belly. Sometimes it can grow large enough to push up on the lungs, which can make it hard for the child to breathe. While stage 4S neuroblastoma is already widespread when it is found, it is very treatable, and it often shrinks or goes away on its own. Almost all children with this form of neuroblastoma can be cured.

Signs or symptoms caused by hormones from the tumor

Neuroblastoma cells sometimes release hormones that can cause problems with tissues and organs in other parts of the body, even though the cancer has not spread to those tissues or organs. These problems are called paraneoplastic syndromes.

Signs and symptoms of paraneoplastic syndromes can include:

• Constant watery diarrhea
• Fever
• High blood pressure (causing irritability)
• Rapid heartbeat
• Reddening (flushing) of the skin
• Sweating

An uncommon set of symptoms is called the opsoclonus-myoclonus-ataxia syndrome or opsoclonus myoclonus ataxia (OMA). This is thought to result from the body’s immune system attacking the normal nerve tissue. A child with this syndrome typically has irregular, rapid eye movements (opsoclonus) and twitch-like muscle spasms (myoclonus), and appears uncoordinated when standing or walking (ataxia). They might also have trouble speaking. Children who have this syndrome tend to have a better outlook when it comes to the neuroblastoma itself, although some children might have long-term nervous system problems, even after the neuroblastoma has been treated. (For more on this, see Late and Long-Term Effects of Neuroblastoma and Its Treatment.)