Symptoms depend on where the tumor is and how much it has spread. They can include a lump in the belly, neck, chest or pelvis. They can also be enlarged lymph nodes (which feel like hard lumps in the armpits or neck) and other signs such as a drooping eyelid, small pupil or sweating on only one side of the body (called Horner syndrome).
Other symptoms may include problems with balance, coordination and movement. Cancer cells can make hormones that cause these signs and symptoms.
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In neuroblastoma, the tumors begin in the tissues that make up the sympathetic nervous system. These control body functions such as heart rate and blood pressure, digestion and levels of certain hormones. The cancer can spread from these areas to other parts of the body such as the bone marrow, liver and skin.
One of the first symptoms is a lump or swelling in the abdomen (belly) or pelvis. It may be painful for your child to eat, which can lead to weight loss. The mass can also be felt as a hard lump underneath the skin. A tumor in the abdominal area can also block blood and lymph vessels, which can cause a lack of fluids (called ascites) in the legs or feet and a feeling of fullness after meals.
If the cancer spreads to the bone marrow (the inner part of bones where new blood cells are made), your child may have low numbers of red and white blood cells, and might get more infections or bruise easily. It can also cause weakness and pain in the bones, arms or legs.
The doctor will check your child for these symptoms by doing a physical exam and getting imaging tests such as a CT scan or an MRI. These scans use x-rays and magnets to create detailed pictures of the body. Other tests might include a MIBG scan, which uses a dye that attaches to neuroblastoma cells and a scanner to take pictures of the bone marrow.
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Often, babies and young children with neuroblastoma have a loss of appetite. They might also lose weight or have a fever. These symptoms might be due to the cancer spreading (metastasizing) to their bones, liver or bone marrow.
Symptoms might also be caused by the tumor pressing on nerves in the chest or neck. This might cause problems with breathing or swallowing. Tumors that press on the spine might cause weakness, numbness or paralysis in the arms or legs. They might also cause a droopy eyelid and small pupil on one side of the face (Horner syndrome).
Most neuroblastomas start in early nerve cells called neuroblasts that are part of what’s called the sympathetic nervous system. These nerves are the network that carries messages from the brain to other parts of the body. They usually begin in the adrenal glands (most common), but they can start anywhere in the nervous system, including in ganglia near the spinal cord or in other organs in the chest, pelvis and abdomen.
A child with this cancer may have many types of tests to check their health and find out if the cancer is growing or has spread. These might include an ultrasound or CT scan of their belly, a chest X-ray and blood and urine tests to check hormone levels. These can be done before, during and after treatment to see if the cancer is going away.
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Diarrhea occurs when cancer cells release hormones that cause your child’s intestines to make more fluids than they should. This can lead to serious dehydration and weakness.
Neuroblastoma starts in early nerve cells of the sympathetic nervous system, which controls involuntary body functions like breathing, heart rate and digestion. It most often starts in the adrenal glands above the kidneys or in sympathetic ganglia near the spinal cord in the chest, neck or pelvis. In some babies, it may disappear on its own (spontaneous regression) or change into a non-cancerous condition called ganglioneuroma.
Sometimes, the tumors can grow large enough to press against blood and lymph vessels in the abdomen or pelvis. This can prevent fluids from getting back to the heart and can cause a buildup of fluid in the legs and, in boys, the scrotum. It can also cause a lump or swelling in the abdomen.
In some cases, neuroblastoma spreads to the liver and bone marrow, which can cause other symptoms, such as fever, high blood pressure and tiredness. Your child’s doctor can check for these symptoms by doing a physical exam and taking a sample of your child’s blood or urine. They might also order a special bone marrow test to see if neuroblastoma has moved to the bone marrow. This involves using hollow needles to get a small amount of marrow from the hip bone and sending it to a lab to test for the presence of cancer cells.
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Most children get neuroblastoma because of changes in their genes. But the cancer can also run in families with certain syndromes (such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and Noonan syndrome).
In some cases, doctors discover neuroblastoma when they feel a lump or mass in a child’s abdomen (belly) or pelvis during a regular well visit. Other times, they find out about it when a child complains of pain or other symptoms.
The symptoms of neuroblastoma vary depending on where the tumor is, how big it is, and whether it has spread to other organs. Bone pain in the long bones of the arms and legs, or in the ribs, is common. It may also cause a feeling of weakness or paralysis in the legs or arms, or a change in the way a child walks or runs. These problems are caused by the cancer affecting the nerve fibers that control movement.
If the cancer has spread to the liver, skin, or bone marrow, it may cause other signs and symptoms, including a feeling of being cold and fever, bruises, or red or purple bumps that look like small blueberries on the skin. Doctors will use imaging tests, such as X-rays, CT scans, ultrasound, and MRI to see if the tumor is in the bones or other tissues of the body. They will also use a special type of urine test to measure substances called vanillylmandelic acid and homovanillic acid, which are released by the dying neuroblastoma cells and can be detected in the bloodstream.