Childhood Cancer

Childhood Cancer

Signs and symptoms

Children with neuroblastoma often experience a number of different signs and symptoms, depending largely on the location of the primary tumor and whether the disease has spread (metastasized) to other locations in the body.

Mikey (4 years old) was always a sickly child and he was constantly on antibiotics for one ailment or another. The night before we took him to the emergency room, he had fallen into his toy box and hurt his abdomen. He wasn’t in any pain, but overnight a huge mass began to appear. He was asleep on my bed lying on his side and we could see a mass protruding from his upper left abdomen area. We never imagined it could be a tumor.


Nelson (age 6) was having a lot of trouble with constipation. The pediatrician did a lot of x-rays to see where he was blocked. On the last x-ray, they caught the bottom of his lung field and saw that one lung was full of fluid. The pediatrician sent us to the local hospital to tap the fluid and then they found a huge mass. It was pushing his kidney into his intestines and blocking them. It came up behind his liver and lungs.

In many cases, parents find a lump or mass in the abdomen while dressing or bathing their young child. The abdomen may appear enlarged, or the child may experience intermittent abdominal pain. The child may stop eating, lose weight, or experience diarrhea and vomiting. Children with neuroblastoma may have fever and they may be unusually tired and irritable. If disease has spread to the bones, the child may begin to limp, refuse to stand, or describe pain in the bones. Neuroblastoma sometimes spreads to the bones of the skull and orbits (bones around the eyes). This may make one or both of the eyes protrude, or the child may develop dark circles around the eyes due to bleeding into the tumor. This is often referred to as “raccoon eyes.”

Initially, when our son began limping, we attributed it to normal growing pains. There were no other signs that it could be a more serious situation. We took him to a doctor a few days after the limping started, and he didn’t seem to feel it was a cause for great concern, either. Shortly after that, our son began to complain of leg pains and soon he was unable to walk at all.

If the tumor involves the spinal cord, the child may have back pain and difficulty passing urine or stool. Tumors located in this area sometimes cause spinal cord compression that can result in stumbling, weakness, or paralysis. Children whose disease has spread to the bone marrow may have pale skin from low numbers of red blood cells, and/or tiny red dots under the skin (petechiae) due to low numbers of platelets. Tumors growing in the chest may cause a chronic cough or difficulty breathing.

Charlotte was ahead on every single milestone by 4 months old. She was very active and could sit alone. It was very noticeable when, on Father’s Day, her legs stopped moving. Her legs were spread out in “frog pose” and she looked uncomfortable when we sat her up. We went to see her pediatrician the next day, and he said there was something wrong but he didn’t know what it was.

Horner syndrome is a rare disorder that is sometimes associated with a mediastinal (in the chest) or cervical (in the neck) neuroblastoma. It occurs when the nerve to the eye is damaged or disrupted by a tumor high in the chest. It may also occur after surgery to remove a tumor in the neck or chest. With this syndrome, the eyelid droops, the pupil looks small, and the child may not sweat on the side of the face with the affected eye.

My son had a strange reaction after his surgery in which he developed a red flush on exactly one side of his face and neck. The anesthesiologist called it Horner syndrome, and was interested in it enough to take a photograph of it for research purposes.

Opsoclonus-myoclonus syndrome (OMS) is another rare manifestation that can accompany neuroblastoma. It is sometimes referred to as “dancing eyes–dancing feet syndrome” because of rapid, uncontrollable movement of the eyes, and sudden, jerky movements of the feet and legs. OMS is usually associated with a localized, mature tumor that has a good prognosis. However, OMS may be associated with developmental delay, and these symptoms may persist or recur. Only about half of OMS cases are associated with neuroblastoma.

Rachel was 3 years old when she first developed symptoms. One of her eyes started turning in and she lost most of her vision in that eye (she regained it after treatment). The doctor did some scans and a biopsy, and diagnosed her neuroblastoma. She had a primary tumor on her right adrenal gland, but there was a much larger tumor in her sinus cavity, behind her right eye. Her urine catecholamine levels were never elevated.

Another unusual syndrome associated with favorable, mature neuroblastomas is vasoactive intestinal peptide (VIP) syndrome. Children with this syndrome have abdominal distension and watery diarrhea, but because it is caused by a protein made by the tumor, VIP syndrome goes away once the tumor is removed.