10 Warning Signs and Symptoms of Neuroblastoma You Should Know

Neuroblastoma is a rare type of cancer that develops from immature nerve cells found in several areas of the body. It most commonly affects children under the age of 5 and is one of the most common cancers in infants. This cancer typically begins in the adrenal glands, which sit atop the kidneys, but can also develop in nerve tissue along the spine, chest, abdomen, or pelvis.

Understanding the symptoms of neuroblastoma is crucial for early detection and timely medical intervention. The signs can vary significantly depending on where the tumor is located and whether it has spread to other parts of the body. Parents and caregivers should be aware of these warning signs to seek prompt medical evaluation when necessary.

In this comprehensive guide, we’ll explore the most common symptoms of neuroblastoma, helping you recognize potential warning signs that warrant medical attention.

1. Abdominal Swelling and Mass

One of the most noticeable symptoms of neuroblastoma is abdominal swelling or a palpable mass in the belly area. This occurs because neuroblastoma tumors frequently develop in the adrenal glands or along the nerve tissue in the abdomen.

Parents may notice that their child’s abdomen appears distended, bloated, or asymmetrical. The child might complain of a feeling of fullness or discomfort in the stomach area, even without eating much. In some cases, the mass may be large enough to be felt during a physical examination or even visible to the naked eye.

Key characteristics include:

• Firm or hard feeling when touching the abdomen
• Progressive increase in abdominal size
• Discomfort or pain when pressure is applied
• Visible asymmetry of the belly

2. Bone Pain and Limping

When neuroblastoma spreads to the bones, it can cause significant pain and discomfort. Children may experience aching in their legs, arms, back, or other skeletal areas. This bone pain is often more severe at night and may interfere with sleep patterns.

The pain occurs because cancer cells infiltrate the bone tissue and bone marrow, causing inflammation and structural damage. Children may be reluctant to walk, run, or engage in normal physical activities. Parents might notice their child limping, favoring one leg, or refusing to bear weight on certain limbs.

Additional signs include:

• Persistent complaints of leg or arm pain
• Difficulty walking or altered gait
• Refusal to participate in previously enjoyed activities
• Pain that worsens with movement or at night
• Irritability due to chronic discomfort

3. Fever and Persistent Infections

Unexplained fever is a common symptom in children with neuroblastoma. The fever may come and go without an obvious cause such as a cold or flu. It typically doesn’t respond well to standard fever-reducing measures and may persist for weeks.

The fever occurs as the body’s immune system responds to the presence of cancer cells. Additionally, when neuroblastoma affects the bone marrow, it can interfere with the production of healthy white blood cells, making children more susceptible to infections.

Watch for these patterns:

• Recurrent fevers without clear infection source
• Temperature fluctuations throughout the day
• Fever lasting more than a week
• Frequent respiratory or other infections
• Slow recovery from common illnesses

4. Fatigue and Weakness

Children with neuroblastoma often experience profound fatigue that doesn’t improve with rest. This exhaustion goes beyond normal childhood tiredness and can significantly impact a child’s daily activities and quality of life.

The fatigue results from multiple factors: the cancer itself consumes the body’s energy resources, anemia develops when cancer affects bone marrow function, and the body’s immune response to fighting the disease drains energy reserves. Children may appear listless, lose interest in play, require frequent naps, or show decreased stamina during routine activities.

Common manifestations include:

• Excessive sleepiness during the day
• Reduced participation in play and social activities
• Lack of energy for age-appropriate tasks
• Pale or washed-out appearance
• General weakness and decreased physical endurance

5. Loss of Appetite and Weight Loss

A noticeable decrease in appetite accompanied by unexplained weight loss is a significant warning sign of neuroblastoma. Children may show disinterest in favorite foods, eat significantly smaller portions, or refuse meals altogether.

This symptom occurs for several reasons: abdominal tumors can create a sensation of fullness, cancer cells release substances that suppress appetite, and the metabolic demands of the tumor can cause weight loss even with adequate calorie intake. Parents might notice that their child’s clothes fit more loosely or that the child appears thin and frail.

Indicators to monitor:

• Consistent refusal of meals and snacks
• Rapid or progressive weight loss
• Complaints of feeling full quickly
• Loss of interest in previously enjoyed foods
• Visible decrease in body mass and muscle tone

6. Eye Problems and Bruising Around the Eyes

Distinctive eye symptoms can occur when neuroblastoma spreads to the area around the eyes or when tumors develop in the skull. One characteristic sign is the appearance of dark circles or bruising around the eyes, often described as “raccoon eyes” or periorbital ecchymosis.

Children may also experience bulging eyes (proptosis), where one or both eyes appear to protrude forward from the eye socket. This happens when tumor growth behind the eye pushes it forward. Other eye-related symptoms include drooping eyelids, unequal pupil sizes, or vision changes.

Eye-related symptoms include:

• Dark purple or blue discoloration around both eyes
• Swelling of the eyelids
• One or both eyes appearing to bulge outward
• Drooping of one eyelid
• Different pupil sizes (anisocoria)
• Complaints of vision problems or double vision

7. Respiratory Difficulties

When neuroblastoma tumors develop in the chest area, they can press against the airways, lungs, or surrounding structures, leading to breathing problems. Children may experience shortness of breath, wheezing, or persistent coughing that doesn’t resolve with typical cold or allergy treatments.

Parents might notice their child breathing more rapidly than normal, using extra effort to breathe (visible chest retractions), or experiencing difficulty breathing while lying flat. The child may prefer to sleep propped up or sitting upright to ease breathing discomfort.

Respiratory warning signs:

• Chronic cough without improvement
• Wheezing or noisy breathing
• Rapid or labored breathing
• Chest pain or discomfort
• Difficulty catching breath during normal activities
• Preference for sitting upright rather than lying down

8. Diarrhea and Bowel Problems

Some children with neuroblastoma experience persistent diarrhea that can be severe and watery. This occurs because neuroblastoma cells can produce certain hormones and other substances, including vasoactive intestinal peptide (VIP), which affects intestinal function and causes increased bowel movements.

The diarrhea associated with neuroblastoma is typically chronic, meaning it lasts for an extended period, and doesn’t respond to standard dietary changes or over-the-counter remedies. It can lead to dehydration, electrolyte imbalances, and additional weight loss if not properly managed.

Digestive symptoms to watch for:

• Frequent, watery bowel movements
• Chronic diarrhea lasting several weeks
• Abdominal cramping or discomfort
• Signs of dehydration (dry mouth, decreased urination)
• Bloating or gas

9. High Blood Pressure

Unexpectedly elevated blood pressure in young children can be a symptom of neuroblastoma, particularly when tumors develop in or near the adrenal glands or compress blood vessels. The adrenal glands produce hormones that regulate blood pressure, and tumors in this area can cause excessive hormone production.

High blood pressure in children is less common than in adults, making it an important finding that requires investigation. Children may not show obvious symptoms of hypertension, which is why it might only be detected during a routine medical examination. However, some children may experience headaches, dizziness, or nosebleeds.

Related signs include:

• Persistent headaches
• Dizziness or lightheadedness
• Frequent nosebleeds
• Flushed or red face
• Irritability or mood changes

10. Neurological Symptoms and Movement Problems

When neuroblastoma affects the spinal cord or spreads to the nervous system, it can cause a range of neurological symptoms. Children may experience weakness in the legs or arms, difficulty with coordination, or problems with balance and walking.

In some cases, compression of the spinal cord by a tumor can lead to more severe symptoms such as paralysis or loss of bladder and bowel control. Some children develop a condition called opsoclonus-myoclonus syndrome (OMS), also known as “dancing eyes, dancing feet” syndrome, characterized by rapid, irregular eye movements and jerky, uncoordinated movements of the limbs and trunk.

Neurological warning signs:

• Weakness or numbness in arms or legs
• Difficulty walking or maintaining balance
• Uncoordinated movements or clumsiness
• Rapid, chaotic eye movements
• Muscle twitching or jerking
• Loss of previously acquired motor skills
• Bladder or bowel control problems
• Changes in sensation or tingling

Main Causes of Neuroblastoma

The exact cause of neuroblastoma remains largely unknown, but researchers have identified several factors that may contribute to its development:

Genetic Mutations: Most cases of neuroblastoma occur sporadically due to genetic changes that happen after birth. These acquired mutations affect the neuroblast cells (immature nerve cells) and cause them to grow and divide uncontrollably instead of maturing into normal nerve cells or dying naturally.

Hereditary Factors: A small percentage (1-2%) of neuroblastoma cases are hereditary, meaning they run in families. Children who inherit certain gene mutations, particularly in the ALK or PHOX2B genes, have an increased risk of developing neuroblastoma. These inherited cases typically occur in younger children and may involve multiple tumors.

Congenital Abnormalities: Children born with certain congenital conditions have a slightly higher risk of developing neuroblastoma. These include:

• Beckwith-Wiedemann syndrome
• Hirschsprung disease
• Central hypoventilation syndrome
• Other genetic disorders affecting neural crest cell development

Age and Development: Neuroblastoma develops from neuroblast cells that normally mature into nerve cells or form the adrenal glands before birth. In neuroblastoma, these cells don’t mature properly and instead continue growing abnormally. This is why the disease primarily affects infants and young children.

Chromosomal Abnormalities: Many neuroblastoma tumors show specific chromosomal changes, including deletion of parts of chromosome 1 or amplification of the MYCN gene. These chromosomal abnormalities are acquired rather than inherited and contribute to tumor development and aggressiveness.

It’s important to note that in most cases, there is nothing parents could have done to prevent neuroblastoma, as it typically results from random genetic changes that occur during fetal development or early childhood.

Prevention of Neuroblastoma

Unfortunately, there are no known proven methods to prevent neuroblastoma. Because most cases occur due to random genetic mutations that happen during early development, and the exact triggers for these mutations remain unknown, specific prevention strategies have not been established.

However, there are some general recommendations for families and parents:

Genetic Counseling: Families with a history of neuroblastoma should consider genetic counseling. While hereditary cases are rare, genetic testing and counseling can help identify families at higher risk and provide information about surveillance strategies for early detection.

Prenatal and Early Childhood Care: Maintaining good prenatal care and regular pediatric check-ups is important. While these measures don’t prevent neuroblastoma, they ensure that any unusual symptoms or signs are detected early, which can improve treatment outcomes.

Awareness of Symptoms: The most practical approach for parents is to be aware of the warning signs and symptoms of neuroblastoma. Early detection, while not prevention, can lead to earlier treatment initiation and potentially better outcomes.

Research Participation: Families affected by neuroblastoma may consider participating in research studies. This helps scientists better understand the causes of the disease and may eventually lead to prevention strategies in the future.

It’s crucial to understand that no lifestyle factors, environmental exposures, or parental behaviors during pregnancy have been definitively linked to causing neuroblastoma. Parents should not feel guilty or responsible if their child develops this condition.

Frequently Asked Questions

What age group is most affected by neuroblastoma?

Neuroblastoma primarily affects infants and young children, with about 90% of cases diagnosed before age 5. The median age at diagnosis is approximately 18 months. It is very rare in children older than 10 years and extremely uncommon in adults.

Is neuroblastoma always cancerous?

Yes, neuroblastoma is a type of cancer. However, it has unique characteristics compared to other cancers. In some very young infants, particularly those under 12 months, neuroblastoma tumors can spontaneously regress or mature into benign tissue without treatment, though this is not common.

How quickly do neuroblastoma symptoms develop?

The onset of neuroblastoma symptoms varies considerably. Some children may develop symptoms rapidly over weeks, while others may show gradual changes over months. The speed often depends on how aggressive the tumor is and where it’s located. Any persistent or worsening symptoms should be evaluated promptly by a healthcare provider.

Can neuroblastoma be detected before symptoms appear?

Sometimes neuroblastoma is discovered incidentally during imaging tests or physical examinations performed for other reasons. Some countries have experimented with mass screening programs for infants, but these have not been widely adopted because many detected tumors would have resolved spontaneously without causing harm.

Are the symptoms of neuroblastoma similar to other childhood illnesses?

Yes, many neuroblastoma symptoms—such as fever, fatigue, and abdominal pain—can mimic common childhood illnesses. This is why persistent symptoms that don’t resolve with typical treatments, or combinations of unusual symptoms, should be thoroughly evaluated by a pediatrician. The key is persistence and progression of symptoms rather than their initial presence.

What should I do if I notice these symptoms in my child?

If you notice any persistent or concerning symptoms in your child, schedule an appointment with your pediatrician promptly. While most symptoms will have benign explanations, early evaluation is important. Be prepared to provide detailed information about when symptoms started, how they’ve progressed, and any changes you’ve observed in your child’s behavior or health.

Does having one symptom mean my child has neuroblastoma?

No, having one symptom does not mean your child has neuroblastoma. Most of these symptoms are much more commonly caused by other, non-cancerous conditions. However, the presence of multiple symptoms, particularly those that persist or worsen over time, warrants medical evaluation to rule out serious conditions including neuroblastoma.

Can neuroblastoma symptoms come and go?

Some symptoms of neuroblastoma, such as fever and pain, may fluctuate in intensity or seem to come and go. However, there is typically an overall pattern of persistence or gradual worsening rather than complete resolution. If symptoms seem to improve but then return, or if new symptoms develop, medical evaluation is warranted.

References:

• American Cancer Society – Neuroblastoma
• National Cancer Institute – Neuroblastoma
• Mayo Clinic – Neuroblastoma
• Children’s Oncology Group – Neuroblastoma
• St. Jude Children’s Research Hospital – Neuroblastoma