Symptoms of Neuroblastoma

Most symptoms of neuroblastoma are caused by the growth of the cancer into nearby tissues or organs, or its spread to distant parts of the body such as bones or bone marrow. 

Symptoms may include:

• lump or swelling in the abdomen (belly), neck or chest, or under the skin 
• stomach pain, feeling full or not wanting to eat, usually with weight loss 
• swelling in the arms or legs (if a tumour is pressing on blood vessels or lymph vessels)
• problems going to the toilet (if the cancer grows into the bladder or bowel)
• bulging eyes, or dark circles around the eyes jerky, uncontrolled eye movements 
• bone pain 
• other unexplained pain weakness or paralysis (if the cancer is pressing on the nerves or spinal cord)
• trouble breathing or swallowing.

In some cases, neuroblastoma produces certain hormones that can cause diarrhoea, high blood pressure, rapid heartbeat, sweating and flushing of the skin.

Note about symptoms

Many conditions – including common childhood infections – can cause these symptoms, not just neuroblastoma. If your child has any of these symptoms and you are concerned, talk to your child’s doctor.

Diagnosis

Your child will have a number of tests to investigate their symptoms and confirm a diagnosis of neuroblastoma, including:

• medical history and physical examination 
• blood tests 
• urine tests 
• medical imaging, which may include:
• X-ray
• Ultrasound
• computed tomography (CT) scan
• magnetic resonance imaging (MRI)
• bone scan
• metaidobenzylguanidine (MIBG) scan
• positron emission tomography (PET) scan
• biopsy – where a small sample of the cancer is removed to be examined under a microscope.The sample can also be tested for genetic changes that can help determine the best type of treatment for your child
• bone marrow aspiration and biopsy – where a sample of bone marrow is taken with a small piece of bone to be examined under a microscope. This is done from 2 separate places in the body at the same time (called a bilateral bone marrow aspiration). 

Your child will probably have more than one of these tests.

The tests are designed to diagnose neuroblastoma, as well as determine the size of the tumour, its exact location in the body and whether it has spread to other parts of the body. The most commonplaces it spreads to are the lymph nodes, liver, bones and bone marrow, and sometimes the skin.

Staging

If your child is diagnosed with neuroblastoma, some of the diagnostic tests will also help to stage the tumour. Staging determines where the tumour is, how big it is, which nearby organs are involved and whether the cancer has spread to other parts of the body. This is important to determine the outlook (prognosis) for your child, and to decide on the best options for treatment.

There are different ways of staging neuroblastoma – the following is the most commonly used:

Stage 1 

The tumour is only in 1 part of the body, and all of the tumour that can be seen has been removed by surgery.

Stage 2 

Stage 2 includes stages 2A and 2B: 

• Stage 2A – the tumour is only in 1 part of the body, but not all of the tumour that can be seen has been removed by surgery
• Stage 2B – the tumour is only in 1 part of the body, and all of the tumour that can be seen has been removed by surgery. However, there are neuroblastoma cells in nearby lymph nodes.

Stage 3 

Stage 3 involves 1 of the following:

• The tumour has not been completely removed by surgery and has spread to the other side of the body or to nearby lymph nodes
• The tumour is on 1 side of the body but has spread to lymph nodes on the other side of the body
• The tumour is in the middle of the body and cannot be completely removed by surgery. It has spread to tissues or lymph nodes on both sides of the body.

Stage 4 

Stage 4 includes stages 4 and 4S:

• Stage 4 – the tumour has spread to other parts of the body such as distant lymph nodes, liver,bones or bone marrow, or the skin
• Stage 4S (also called special neuroblastoma) – the child is less than 1 year old. The tumour is only in 1 part of the body, and all the tumour that can be seen may be removed by surgery.However, the cancer has spread to the liver, skin or bone marrow, and maybe the lymph nodes near the tumour.

This information is reproduced with permission of Cancer Australia and you can download the full Cancer Australia’s Neuroblastoma Fact Sheet here.

Read next: Treatment and Side Effects

More information

• Symptoms - Cancer Australia 
• Diagnosis - Cancer Australia
• Signs and symptoms of neuroblastoma - American Cancer Society
• If your child has neuroblastoma - American Cancer Society
• General information about neuroblastoma - PDQ Neuroblastoma Treatment*
• Stages of Neuroblastoma - PDQ Neuroblastoma Treatment*