Neuroblastoma Signs & Symptoms
Neuroblastoma is a rare cancer that develops in infants and young children from immature nerve cells, most often in the nerve tissue of the adrenal glands. Because neuroblastoma symptoms can look very different from one child to the next, this guide is written for parents and caregivers, to help you recognize the signs early and know when to talk to your child’s doctor.
Key Takeaways
- Neuroblastoma develops from immature nerve cells and most often begins in the adrenal glands, so many of its symptoms show up as a lump or swelling in the abdomen, though tumors can also form in the neck, chest, or along the spine.
- Bone pain and a painless lump in your child’s neck, chest, or belly are among the most common neuroblastoma symptoms, though because this cancer is rare, these signs usually have a more common, non-cancerous cause.
- How symptoms show up can differ by age: some infants develop a swollen belly with breathing trouble or small bluish skin nodules, while older children more often have bone pain or changes around the eyes.
- Because the cancer can spread to the eyes, skin, bones, or nervous system, it can also cause dark circles or bulging around the eyes and, rarely, sudden jerky eye and muscle movements.
- Any persistent, worsening, or unusual symptom in your child is worth a prompt visit to their doctor, since early evaluation supports timely diagnosis and more treatment options.
Common Neuroblastoma Symptoms
Recognizing neuroblastoma symptoms can be difficult for parents, since they are often nonspecific and easy to mistake for more common childhood illnesses. Symptoms generally come from the primary tumor pressing on nearby tissue as it grows, or from cancer that has spread to another part of the body. Because many common signs of neuroblastoma can look like everyday childhood complaints, persistent or unusual changes are worth mentioning to your child’s doctor.
Abdominal Mass and Swelling
An abdominal mass is the most common way neuroblastoma first appears. This cancer most often begins in the adrenal medulla — the inner part of the adrenal gland, made up of sympathetic nervous system tissue — though it can also arise in nerve tissue that runs along the spine, anywhere from the neck or chest down to the abdomen or pelvic region. This is a different part of the adrenal gland, and a different disease, from adrenocortical carcinoma, which begins in the hormone-producing outer layer, or cortex. When a tumor grows in or near the adrenal glands, parents may notice a firm, irregular lump in the belly or a swollen abdomen; in infants, a large abdominal tumor that has spread to the liver can also cause a swollen belly along with trouble breathing. Reduced appetite can occur as well, though most children with these symptoms will not have neuroblastoma, since it is a rare cancer.
Unexplained Pain and Fatigue
Persistent bone pain, one of the more common neuroblastoma symptoms, can occur when the cancer has spread to the bones. Extensive bone marrow involvement can lower blood cell counts, which may show up as fatigue, easy bruising, or bleeding; fever and anemia are also sometimes seen, even without spread. Because these symptoms have many possible causes in children, persistent, unexplained tiredness or pain that does not improve is worth discussing with your child’s doctor.
Age-Specific Signs of Neuroblastoma
How neuroblastoma symptoms by age present can vary, since this disease is most often diagnosed very early in life. According to the National Cancer Institute, the median age at diagnosis is under 2 years old, and about 9 in 10 children are diagnosed before age 5. Knowing what to watch for at different ages can help parents and caregivers.
In Infants and Toddlers
Neuroblastoma is most often diagnosed during a baby’s very first months, and it is sometimes found even before birth on a prenatal ultrasound, or noticed unexpectedly when a doctor examines your child for an unrelated reason. In very young children, a parent might notice an enlarged abdomen, irritability, or reduced appetite. Some infants develop small, painless, bluish or purplish nodules under the skin — sometimes described as looking like blueberries — a sign that the cancer has spread to the skin; this is generally seen only in infants.
In Older Children
In older children, neuroblastoma symptoms more often relate to where the cancer has spread. Bone pain is a frequent complaint, and if the cancer reaches the area behind the eye, a child may develop bulging of one or both eyes or dark circles around the eyes caused by bleeding related to the tumor; this combination is seen more often in children with more advanced disease. The overall pattern of symptoms in adolescents is largely similar to that in younger children, though spread to less typical sites such as the lungs or brain is somewhat more frequent, and bone marrow involvement is somewhat less frequent, in this older age group.
Recognizing Early Signs of Neuroblastoma
Early detection can make a meaningful difference for children with neuroblastoma. Knowing how to recognize this cancer means paying attention to persistent or unusual changes in your child’s health and behavior, since the early signs of neuroblastoma in children are often subtle.
Subtle Changes to Watch For
Parents and caregivers should watch for subtle but persistent changes that could point to an underlying problem, such as ongoing low-grade fever, unusually pale skin, or reduced appetite. On rare occasions, a neuroblastoma tumor can release a hormone that causes severe, watery diarrhea, which may be the very first symptom a family notices. Because most of these changes have common, non-cancer explanations, it is the persistence of a symptom over time — more than any single sign on its own — that should prompt a closer look.
Persistent or Worsening Symptoms
What generally sets neuroblastoma apart from ordinary childhood illnesses is how long a symptom lasts and whether it is getting worse. Ongoing pain, swelling, fever, or fatigue that does not resolve over time deserves medical attention, as does breathing difficulty that could point to a tumor in the chest, or new weakness, numbness, or trouble moving an arm or leg, which can mean the spinal cord is affected. Trusting your instincts as a parent and seeking medical advice for any concerning or unusual symptom is a reasonable step.
Diverse Manifestations of Neuroblastoma
Neuroblastoma can show up in many different ways depending on where the primary tumor is and where it has spread, which is why understanding the full range of neuroblastoma symptoms matters for parents and caregivers.
Eye and Skin Symptoms
When neuroblastoma spreads to the area behind the eye, it can cause bulging of one or both eyes and dark circles or bruising around the eyes from bleeding related to the tumor — sometimes called “black eyes” or, informally, “raccoon eyes.” In infants, small bluish or purplish lumps under the skin that look a bit like blueberries are a sign the cancer has spread to the skin; these nodules are usually painless.
Neurological and Bone Symptoms
If a tumor grows near the spine and presses on the spinal cord, it can cause weakness, numbness, paralysis, or loss of bladder or bowel control; because spinal cord compression is treated as a medical emergency, sudden neurological symptoms like these need immediate medical attention. A rare paraneoplastic condition linked to neuroblastoma is opsoclonus-myoclonus syndrome, which causes rapid, uncontrolled eye movements (opsoclonus) and sudden muscle jerks (myoclonus), sometimes together with unsteady movements (ataxia); when young children develop this syndrome, about half are ultimately found to have neuroblastoma. Bone pain related to metastatic disease is also common and can affect a child’s willingness or ability to be active.
When to Consult a Doctor
Knowing the signs of neuroblastoma is the first step; knowing when to seek medical care is just as important, since prompt evaluation can lead to an earlier diagnosis and more treatment options.
Red Flags for Medical Evaluation
According to the National Cancer Institute, you should check with your child’s doctor promptly if you notice any of the following neuroblastoma diagnosis symptoms: a new lump or swelling in the belly, the neck, or the chest area; bone pain that does not go away; in an infant, a swollen belly together with breathing trouble; eyes that look like they are bulging, or dark circles appearing around them; in an infant, small, painless bluish or purplish lumps forming under the skin; new weakness or an inability to move a body part normally; and, less often, unexplained fever, high blood pressure, very watery diarrhea, the triad of eyelid droop, pupil constriction, and one-sided facial sweating loss that together make up Horner syndrome, easy bruising or bleeding, or sudden jerky movements of the muscles or eyes. Because these signs can come from many different, more common childhood conditions, only a doctor’s exam can tell whether further testing for neuroblastoma is needed.
Importance of Early Diagnosis
Diagnosing neuroblastoma early matters because it generally means the tumor is more localized and more treatable, often with less intensive therapy. A delayed diagnosis can allow the cancer to spread further before treatment starts, which can mean more aggressive and prolonged treatment. How the specific stage and biology of a child’s tumor affects outlook is covered in more detail on this site’s pages about neuroblastoma stages and survival rates — but broadly, trusting your instincts as a parent and having persistent or concerning symptoms checked out gives your child’s care team the best chance of catching the disease at its earliest, most treatable point.
Frequently Asked Questions
What is neuroblastoma and how common is it?
Neuroblastoma is a rare cancer that forms in immature nerve cells, most often in the adrenal medulla or in sympathetic nerve tissue that runs from the neck down to the pelvis. It is a disease of early childhood — most children are diagnosed before age 5 — and it is the single most common cancer found during a child’s first year of life, with roughly 650 new diagnoses in the United States each year.
Are there specific tests for neuroblastoma?
Diagnosis usually starts with a physical exam and urine tests that measure catecholamine byproducts (VMA and HVA), which are often elevated in neuroblastoma. Imaging such as ultrasound, CT, MRI, or a specialized MIBG scan helps locate the tumor and check whether it has spread, and a biopsy is typically needed to confirm the diagnosis under a microscope.
Can neuroblastoma be cured?
Outcomes vary widely and depend on factors such as a child’s age at diagnosis, how far the cancer has spread, and specific biological features of the tumor. Many children with lower-risk disease do very well, sometimes with close observation alone or less intensive treatment, while higher-risk disease is harder to treat, though outcomes have improved substantially with modern combination therapies. For a fuller picture of prognosis and treatment approaches, see this site’s pages on neuroblastoma stages, survival rates, and treatment options.
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