Neuroblastoma is a type of cancer that originates in very early forms of nerve cells, known as neuroblasts, which are typically found in an embryo or fetus. As a solid tumor, it most commonly begins in the adrenal glands, which are situated on top of the kidneys, but can also develop in nerve tissue along the spine in the neck, chest, abdomen, or pelvis. This cancer primarily affects infants and young children, making it one of the most common cancers in this age group. Understanding its symptoms is critically important because they are often vague and can easily be mistaken for more common and less serious childhood illnesses, which can delay diagnosis and treatment.
The signs and symptoms of neuroblastoma are highly variable and depend significantly on several factors, including the primary location of the tumor, its size, and whether the cancer has spread (metastasized) to other parts of the body. A small tumor confined to one area may produce few, if any, noticeable symptoms initially. However, as the tumor grows or spreads, the symptoms become more pronounced and are directly related to the structures being compressed or affected by the cancer cells. This variability is why a single, definitive list of symptoms does not apply to every child, and why parents and healthcare providers must consider a wide range of potential indicators.
Given the diverse presentation of the disease, several key symptoms are commonly associated with neuroblastoma. While a child may not experience all of them, the presence of one or more warrants medical evaluation.
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A Lump or Swelling in the Abdomen: This is one of the most frequent signs, occurring when the tumor originates in the adrenal glands or other nerve tissue in the abdominal area. The lump may feel hard and may or may not be tender to the touch. This abdominal mass can also lead to secondary symptoms such as a feeling of fullness, unexplained weight loss, constipation, or difficulty urinating, as it presses on surrounding organs.
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Bone Pain and Limping: Neuroblastoma has a tendency to spread to the bones, which can cause significant pain. A young child may not be able to articulate this pain and might instead exhibit changes in behavior, such as becoming unusually fussy or irritable, refusing to walk, or starting to limp. Pain may be more noticeable at night or when the child is being picked up or handled.
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Changes Around the Eyes: The spread of neuroblastoma to the bones around the eye sockets can produce very distinct and concerning signs. These include dark circles that resemble bruises, often referred to as "raccoon eyes," and bulging of one or both eyes (proptosis). A tumor in the neck or chest can also damage nerves that control the eye, leading to a drooping eyelid (ptosis) and a smaller pupil on one side of the face.
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Unexplained Fever, Fatigue, and Pallor: Like many cancers, neuroblastoma can cause general, systemic symptoms. A persistent, low-grade fever with no clear cause, such as an infection, can be a warning sign. Children may also experience extreme tiredness or lethargy that does not improve with rest. The cancer can also affect the bone marrow, leading to a reduced production of red blood cells (anemia), which results in pale skin (pallor).
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Neurological and Hormonal Issues: Depending on its location, the tumor can impact the nervous system. A tumor pressing on the spinal cord can cause weakness in the legs, an unsteady gait, or even paralysis. In some cases, neuroblastoma cells produce excess hormones called catecholamines, leading to symptoms like high blood pressure, rapid heartbeat, sweating, and irritability. A rare but specific associated condition is opsoclonus-myoclonus-ataxia syndrome (OMAS), characterized by rapid, uncontrolled eye movements (opsoclonus), muscle jerks (myoclonus), and problems with balance and coordination (ataxia).
What can trigger neuroblastoma?
In most instances, a specific trigger for neuroblastoma is never identified, as the exact cause remains largely unknown. The cancer originates from very early forms of nerve cells known as neuroblasts, which are part of a fetus's normal development. While most neuroblasts mature into functioning nerve cells or simply disappear, in neuroblastoma, they fail to develop correctly and instead continue to grow and divide, forming a tumor. Experts suspect this process is triggered by a genetic mutation within the nerve cells themselves. Although heredity can be a risk factor, an inherited genetic alteration is responsible for only a very small percentage of cases, accounting for just 1% to 2% of all diagnoses.
What were your child's first neuroblastoma symptoms?
The initial signs of neuroblastoma can vary significantly from child to child, depending on the tumor's location and size. Many parents first notice a firm, painless lump or mass in their child's abdomen, which might also appear as a swollen stomach, sometimes accompanied by trouble breathing. Other common early symptoms include unexplained bone pain that can cause a limp, or swelling and dark, bruise-like circles that look like "black eyes." In some infants, painless bluish lumps may appear under the skin, while other children might experience persistent fevers, poor appetite, or weakness in their limbs due to the tumor pressing on the spinal cord.
What can neuroblastoma be mistaken for?
Due to its wide range of clinical presentations, neuroblastoma can be mistaken for numerous other conditions. Histologically, as a "small, round blue cell" tumor, it must be differentiated from other malignancies like Ewing's sarcoma, rhabdomyosarcoma, and non-Hodgkin's lymphoma. Clinically, an abdominal mass—the most common presentation—can be confused with a Wilms tumor, which typically presents as a smooth flank mass that does not cross the midline, or with a hepatoblastoma. The symptoms of metastatic disease can also be misleading; widespread bone involvement may mimic osteomyelitis or rheumatoid arthritis, while periorbital ecchymosis from retrobulbar metastasis can be mistaken for trauma or child abuse. In rare cases, symptoms like intractable diarrhea from tumor secretions might be misdiagnosed as an enteric infection or inflammatory bowel disease.
Is neuroblastoma a silent tumor?
Neuroblastoma's clinical presentation is highly variable, so it cannot be universally classified as a silent tumor. While some localized tumors may be discovered before causing significant symptoms, many cases, particularly those in advanced stages, present with clear signs of disease. The specific symptoms depend on the tumor's size, location, and whether it has spread to other parts of the body. For example, infants with a special variant called stage 4S neuroblastoma often have extensive disease with visible skin nodules ("blueberry muffin" lesions) and significant liver enlargement that can cause life-threatening respiratory compromise. This clinical heterogeneity means that while some neuroblastomas are found incidentally, many others cause noticeable and sometimes severe symptoms.
What is the most common presenting feature of neuroblastoma?
The presenting features of neuroblastoma are diverse and depend on the tumor's location, but the most common sign is an abdominal mass, often felt as a lump or seen as a swollen abdomen. This is because most neuroblastomas start in the adrenal glands located in the abdomen and can grow quite large before causing other noticeable problems. Because the cancer often spreads before it is diagnosed, other frequent signs can include bone pain, unexplained fevers, and swelling or bruising around the eyes, which can create a “raccoon eye” appearance. These symptoms are typically caused by the tumor pressing on nearby tissues as it grows or by the cancer spreading to other parts of the body.
Has any child survived neuroblastoma?
Yes, many children survive neuroblastoma, and a significant number are cured of the disease. The outlook, or prognosis, depends heavily on the specific risk category of the cancer, which considers the child’s age and the tumor’s characteristics. For example, children with low-risk disease have an excellent prognosis, and some infants' tumors can even resolve on their own. While high-risk neuroblastoma is much more aggressive, the 5-year survival rate is still around 50%. This means that even for the most challenging cases, about half of the children live for at least five years after diagnosis, with many surviving much longer.
Does neuroblastoma show in blood tests?
Yes, blood tests play a crucial role in diagnosing neuroblastoma by detecting several key indicators. Neuroblastoma cells often produce high levels of hormones known as catecholamines, which can be measured in a child's blood and urine. Doctors also perform a complete blood count (CBC) to check for signs such as anemia, a condition where the body lacks enough healthy red blood cells, which can suggest that the cancer has spread to the bone marrow. Furthermore, other blood tests are used to evaluate how well organs like the liver and kidneys are functioning, as they can be affected by the disease.
