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Symptoms of neuroblastoma

The most common symptom of neuroblastoma is a lump in the tummy (abdomen). This could make your child’s tummy swell, causing discomfort or pain. 

Occasionally, it can affect the spinal cord. This can cause:

  • numbness
  • weakness
  • loss of movement in the lower part of the body

Rarely neuroblastoma can appear as a lump in the neck, this might cause breathlessness or difficulty in swallowing.

Other symptoms depend on where the neuroblastoma starts in the body and whether it is just in one place (localised) or has spread to other parts of the body. 

Symptoms when neuroblastoma has spread

In around half of children (around 50%), the neuroblastoma has spread to another part of the body at diagnosis. The symptoms depend on where it has spread to and how big it is. The most common symptom is bone pain. But symptoms are often vague such as:

  • tiredness
  • fever (high temperatures)
  • loss of appetite

Bones

This is the most common place for neuroblastoma to spread to. Symptoms include pain (sometimes with swelling over the bone) and difficulty in walking. Occasionally it can affect the bones of the spine causing numbness, weakness and loss of movement in the lower part of the body.

Bone marrow

Bone marrow is the spongy substance in the centre of the bones. 

Diagram of bone marrow

It contains early blood cells, called stem cells. These develop into the 3 different types of blood cell.

Diagram of three different types of blood cell

 Neuroblastoma that spreads to the bone marrow might cause:

  • tiredness and paleness due to a low red blood cell count (anaemia)
  • bruising or bleeding due to a low platelet count (sometimes around the eyes)
  • infections due to a low white blood cell count

Skin

Neuroblastoma that spreads to the skin can give it a blue black colour, as if it were bruised. Sometimes, there are small, raised, discoloured lumps that look like blueberries on the skin.

Liver

Spread to the liver might cause tummy swelling and pain. Babies might also have difficulty feeding because the liver has got bigger.

Catecholamines

Catecholamines (cat - a - coal - ay - means) are chemical messengers that send messages between nerve cells. The adrenal glands Open a glossary item make these, one example is adrenaline.

Our bodies break them down into substances that we pass out in our urine. Neuroblastoma tumours often produce catecholamines in large amounts. 

Your child’s doctor tests for this by looking at a blood or urine sample. It is very unusual for it to cause any symptoms. But, very large amounts of catecholamines and other chemicals the neuroblastoma produces can cause symptoms such as:

  • weight loss
  • sweating
  • redness of the skin (flushing) or paleness
  • a fast heartbeat and increased blood pressure
  • watery diarrhoea

Seeing your GP

Having one of these symptoms doesn’t mean your child has neuroblastoma as they can be symptoms of other things. But you should get any changes checked out by their GP.

Referral to a specialist

Your GP should refer your child to a specialist within 2 days if they have any of the following:

  • a lump in the tummy (abdomen)
  • an enlarged or swollen organ in the tummy

There are guidelines to help GPs know when to refer a child to a specialist. These guidelines are very clear that that the GP should take the parent or carers concern about their child into account when deciding about a specialist referral.

The first professional your child might see is a specialist children’s doctor. These doctors are called paediatricians. They might then go on to see a specialist children and young person’s cancer doctor. These doctors are called consultant paediatric oncologists. When you arrive at the hospital, you are likely to see another doctor in the specialist team, called a registrar.

What happens next

Ask your GP what happens next. Make another appointment if you notice any more changes, or you are still concerned.

Tests for neuroblastoma

Find out about the tests your child might have if their doctor suspects they have neuroblastoma.

Last reviewed: 
25 Feb 2021
Next review due: 
25 Feb 2024
  • BMJ Best Practice Neuroblastoma
    J Shohet and others
    BMJ Publishing Group, last updated December 2020

  • Neuroblastoma: Clinical and Biological Approach to Risk Stratification and Treatment
    V P Tolbert and K K Matthay
    Cell and Tissue Research, 2018. Volume 372, Issue 2, Pages 195 – 209

  • Suspected cancer: recognition and referral
    National Institute for Health and Care Excellence (NICE), last updated 2021

  • Cancer in children – clinical management (6th edition)
    MCG Stevens, HN Caron and A Biondi
    Oxford University Press, 2012

  • Updates in Diagnosis, Management, and Treatment of Neuroblastoma
    C C Swift and others
    RadioGraphics, 2018. Volume 38, Issue 2, Pages 566 -580

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.