Diagnosis of neuroblastoma can be extremely complicated. It has
been called the "great masquerader" because its symptoms mimic so many
other diseases. Even a pathological study (biopsy) might reveal cells
that can resemble other small round blue tumor cells. Only a pathologist familiar with neuroblastoma
can distinguish the difference
The signs and symptoms of neuroblastoma can vary widely
depending on the size and location of the original tumor, the extent of
spread to other parts of the body, and whether or not the tumor cells
secrete hormones.
One of the most common signs 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 not want to eat (which can lead to weight
loss) or may complain of feeling full or having discomfort or pain. But
the lump itself is usually not tender to the touch. Masses can also
occur in other places such as the neck.
Sometimes, swelling from the tumor may affect parts of the
body that do not contain any cancer cells, especially the legs and, in
males, the ***. 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 a growing tumor can cause
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,
may make it hard for the child to breathe or swallow.
Neuroblastomas that compress certain nerves in the chest or
neck can sometimes cause other symptoms, such as drooping eyelids and
small pupils (the black areas in the center of the eyes). Pressure on
other nerves near the spine may affect the child's ability to feel or
move the arms or legs.
About 2 out of 3 cases of neuroblastoma have spread to other
parts of the body by the time they are found.
Neuroblastoma frequently spreads to bones. If this has
occurred, a child who can talk may complain of pain in the bones. The
pain may be so bad that the child limps or refuses to walk. If it
spreads to the backbone, tumors may compress the spinal cord and cause
weakness, numbness, or paralysis.
Blue or purple patches that look like small blueberries may
indicate spread to the skin. Sometimes there is bruising around the
eyes. In some cases the neuroblastoma may spread to the back of the
eye, causing it to protrude (stick out slightly).
If the bone marrow (the inner parts of certain bones that make
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 tiredness, irritability, 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.
A special widespread form of neuroblastoma (known as stage 4S)
occurs only during the first few months of life. In this special form,
the neuroblastoma has spread to the liver, to the skin, and/or to the
bone marrow (in small amounts). The liver can become very large.
Despite the fact that the cancer is already widespread when it is
found, stage 4S neuroblastoma is very treatable, and almost all
children can be cured, usually with minimal treatment.
Neuroblastoma is one of the few cancers in children that
release hormones that can cause strange changes in the body. These
changes are called paraneoplastic syndromes.
Symptoms of paraneoplastic syndromes can include:
- fever (in about 1 out of 4 children)
- constant diarrhea
- high blood pressure (causing irritability)
- rapid heartbeat
- reddening (flushing) of the skin
- sweating
An uncommon symptom is called the opsoclonus-myoclonus-ataxia
syndrome or "dancing eyes, dancing feet." In this situation, the child
has irregular, rapid eye movements (opsoclonus), twitch-like muscle
spasms (myoclonus), and appears uncoordinated when standing or walking
(ataxia). He or she may also have trouble speaking. For unknown
reasons, neuroblastoma tumors that cause this syndrome tend to be less
life-threatening than other forms of the disease.
The following tests and procedures may be used: