Signs and Symptoms of Neuroblastoma
Neuroblastoma can start in different places in the body. Neuroblastoma cells may also release hormones, which can affect other parts of the body. Because of this, neuroblastoma can cause many different signs and symptoms.
Common symptoms of neuroblastoma
Some of the signs and symptoms can include:
- Lump or swelling in the child's belly
- Swelling in the legs or in the upper chest, neck, and face
- Eyes that appear to bulge and/or bruising around the eyes
- Drooping eyelid and small pupil (the black area in the center of the eye) in one eye (Horner syndrome)
- Rapid, random eye movements and muscle twitches that make it difficult to balance (Opsoclonus myoclonus)
- Problems being able to feel or move parts of the body
- Lumps or bumps under the skin, which may appear blue
- Weight loss and low appetite
- Irregular bowel movements or trouble urinating
- Bone pain, which can cause limping or trouble walking
- Low blood counts
Signs and symptoms might be different depending on where the tumor is, how large it is, how far it has spread, and if the tumor makes hormones.
Signs or symptoms caused by the main tumor
One of the most common signs of a neuroblastoma is a large lump or swelling in the child’s abdomen. The child might not want to eat (which can lead to weight loss). If the child is old enough, they may complain of feeling full or having belly pain.
Sometimes, a tumor in the abdomen or pelvis can affect other parts of the body. For example, tumors that press against or grow into the blood and lymph vessels in the abdomen or pelvis can stop fluids from getting back to the heart. This can sometimes lead to swelling in the legs and, in boys, the scrotum.
In some cases, the pressure from a growing tumor near the spine can affect the nerves. This can cause pain or trouble moving or feeling, or it might affect the child’s bladder or bowel.
Tumors in the neck can often be seen or felt as a hard, painless lump.
If the tumor is in the chest, it might press on the superior vena cava (the large vein in the chest that returns blood from the head and neck to the heart). This can cause swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color). It can also cause headaches, dizziness, and a change in consciousness if it affects the brain.
Tumors in the chest or neck might also press on the throat or windpipe, which can cause coughing and trouble breathing or swallowing.
Neuroblastomas that press on certain nerves in the chest or neck can sometimes cause other symptoms, such as a drooping eyelid and a small pupil (the black area in the center of the eye), part of a condition known as Horner syndrome.
Pressure on other nerves near the spine might affect the child’s ability to feel or move their arms or legs.
Signs or symptoms caused by cancer spread to other parts of the body
Many neuroblastomas have already spread to the lymph nodes or other parts of the body by the time they are found.
are bean-sized collections of immune cells found throughout the body. Cancer that has spread to the lymph nodes can cause them to swell. These nodes can sometimes be felt as lumps under the skin, especially in the neck, above the collarbone, under the arm, or in the groin.
Neuroblastoma cells can spread to the bones. A child who can talk may complain of bone pain. The pain may be so bad that the child limps or refuses to walk. If it spreads to the bones in the spine, tumors can press on the spinal cord and cause weakness, numbness, or make them unable to move their arms or legs.
Spread to the bones around the eyes can lead to bruising around the eyes or cause an eyeball to stick out slightly. The cancer might also spread to other bones in the skull, causing bumps under the scalp.
If the cancer spreads to the bone marrow (the inner part of certain bones, where new blood cells are made), 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 excess bruising or bleeding from small cuts or scrapes.
Neuroblastoma cells might spread to the liver, which can cause the liver to swell. A large liver may make it hard for a child to breathe or make their abdomen look swollen.
Blue or purple bumps that look like small blueberries may be a sign of spread to the skin. This is rare but more often seen in infants with a special kind of neuroblastoma called stage 4S (MS).
Signs or symptoms caused by hormones from the tumor
Neuroblastoma cells sometimes release hormones that can cause problems with tissues and organs in other parts of the body, even though the cancer has not spread to those tissues or organs. These problems are called paraneoplastic syndromes.
Neuroblastoma cells often make hormones called catecholamines. These are hormones our body naturally makes in response to stress. In some children with neuroblastoma, too much of these stress hormones are made. This can cause high blood pressure, a fast heartbeat, sweating, fevers or flushing of the skin.
Rarely, neuroblastoma cells can make a hormone called VIP (vasoactive intestinal peptide). When this happens, children can have large amounts of watery diarrhea.
Another uncommon set of symptoms in children with neuroblastoma is called opsoclonus-myoclonus-ataxia (OMA). This is thought to result from the body’s immune system attacking the normal nerve tissue. A child with this syndrome typically has irregular, rapid eye movements (opsoclonus) and twitch-like muscle spasms (myoclonus), and appears uncoordinated when standing or walking (ataxia). Children who have this syndrome tend to have a better outlook when it comes to the neuroblastoma itself, although some children might have long-term nervous system problems, even after the neuroblastoma has been treated. (For more on this, see After Neuroblastoma Treatment.)
What to do if you notice symptoms
One or more of these symptoms usually leads to a visit to the doctor. Many of these signs and symptoms are more likely to be caused by something other than neuroblastoma. Still, if your child has any of these symptoms, check with your doctor.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Dome JS, Rodriguez-Galindo C, Spunt SL, Santana VM. Chapter 92: Pediatric solid tumors. In: Neiderhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA. Elsevier; 2020.
Park JR, Hogarty MD, Bagatell R, et al. Chapter 23: Neuroblastoma. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Principles and Practice of Pediatric Oncology. 8th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2021.
Shohet JM, Nuchtern JG. Clinical presentation, diagnosis, and staging evaluation of neuroblastoma. UpToDate. 2021. Accessed at https://www.uptodate.com/contents/clinical-presentation-diagnosis-and-staging-evaluation-of-neuroblastoma on March 15, 2021.
Last Revised: June 26, 2025
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