If a child's signs and symptoms suggest neuroblastoma might be present, additional blood and urine tests, examination of tissue samples, and imaging studies will probably be needed. These tests are important because many of the symptoms and signs of neuroblastoma can also be caused by other cancers or by noncancerous diseases.

Signs and Symptoms

The signs and symptoms of neuroblastoma depend on the location of the original tumor and the extent of spread to nearby or distant parts of the body.

The most common sign of a neuroblastoma is an unusual lump or mass. These are usually found in the child's abdomen, causing it to swell. The child may complain of abdominal fullness, discomfort, or pain, the direct result of a tumor being present. But the lump itself is usually not tender or sore to the touch. Masses can occur in other places such as the neck. Or the neuroblastoma can spread to the back of the eye, causing it to protrude (stick out slightly).

Neuroblastoma frequently spreads to bones. If metastasis to bones has occurred, a child who can talk may complain of pain in the bones. The pain may be so bad that the child limps, refuses to walk, or is unable to walk. If it spreads to the backbone, tumors may compress the spinal cord and cause weakness, numbness, or paralysis.

In about 1 case of 4, the child may develop a fever. Less common symptoms include:

• persistent diarrhea
• high blood pressure (causing irritability)
• rapid heartbeat
• reddening (flushing) of the skin
• sweating

These symptoms and signs result from hormones released by the neuroblastoma cells.

Another uncommon symptom is called the opsoclonus-myoclonus-ataxia syndrome or dancing eyes, dancing feet. In this situation, the child has an unsteady, trembling gait, myoclonus (brief, shock-like muscle spasms), and opsoclonus (irregular, rapid eye movements). They may also have difficulty speaking,. For unknown reasons, neuroblastoma tumors that produce this syndrome are less life-threatening than other forms of the disease.

Sometimes, swelling may affect parts of the body that do not contain any cancer cells, especially the legs and, in males, the scrotum. This happens when tumors in the abdomen or chest press against or invade and clog the blood and lymph vessels, preventing fluids from circulating back to the heart. In some cases the pressure from the growing tumor causes problems with the child's bladder or bowel. Pressure from the tumor on, or invasion into, the superior vena cava (the large vein in the chest that returns blood from the head and neck to the heart) can cause swelling in the face or throat. This, in turn, can make it hard for the child to breathe or swallow.

Neuroblastomas that compress certain nerves in the chest or neck can sometimes cause additional symptoms, such as drooping eyelids and small pupils. Pressure on other nerves near the spine can cause the child to lose the ability to move the arms or legs.

Blue or purple patches, resembling small bruises, may indicate spread to the skin. Sometimes there is bruising around the eyes.

If the bone marrow (the tissue that makes blood cells) is affected, the child may not have enough red blood cells, white blood cells, or blood platelets. These shortages of blood cells can result in weakness, frequent infections, and excessive bleeding from small cuts or scrapes.

Rarely, bleeding can be caused by loss of clotting factors in the blood, which is due to clotting and excessive breakdown of tissue inside a large tumor. This is known as a consumption coagulopathy and can be life threatening.

Finally, there is a special form of disseminated neuroblastoma that only occurs during the first few months of life. In this special form, also called 4S (s for special), the neuroblastoma has spread to the liver, to the skin, and to the bone marrow. The liver can enlarge significantly, and the skin lesions have been compared to blueberries (thus the name blueberry syndrome that is given to this presentation of neuroblastoma). Despite this aggressive presentation, stage 4S neuroblastoma is very treatable, and almost all children can be cured, most of the times with minimal treatment.