When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 21 Mar 2025
Last updated: 31 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age <4 years
  • abdominal distention
  • abdominal mass
  • pain
  • decreased appetite
  • weight loss
  • fussiness (infants)
  • fatigue
  • periorbital ecchymosis (panda eyes)
  • subcutaneous skin nodules
  • family history of neuroblastic tumours
  • signs of spinal cord compression
  • signs of Horner's syndrome
  • signs of superior vena cava syndrome
  • intractable secretory diarrhoea
  • opsoclonus-myoclonus ataxia (OMA)

Other diagnostic factors

  • constipation
  • pallor
  • bleeding
  • infections
  • hypertension
  • hepatomegaly

Risk factors

  • neurocristopathies or other syndromes
  • family history of neuroblastic tumours or genetic predisposition

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • serum creatinine/urea
  • liver function tests (LFTs)
  • serum lactate dehydrogenase (LDH)
  • urine catecholamines
  • ultrasound abdomen
  • CT scan
  • MRI scan

Investigations to consider

  • tumour biopsy
  • bilateral bone marrow aspiration and biopsy
  • serum vasoactive intestinal peptide (VIP)
  • 123-iodine-metaiodobenzylguanidine (MIBG) scintigraphy
  • positron emission tomography with 18-F-deoxyglucose (18F-FDG PET)

Treatment algorithm

Contributors

Authors

Jason Shohet, MD, PhD

Associate Professor

University of Massachusetts

Chan Medical School

Worcester

MA

Disclosures

JS declares that he has no competing interests.

Jennifer Foster, MD, MPH

Clinical Director, Neuroblastoma Program

Associate Professor

Department of Pediatrics Section of Hematology/Oncology

Texas Children's Cancer Center

Baylor College of Medicine

Houston

TX

Disclosures

JF has served on the advisory board for Y-mAbs Therapeutics and Fennec Pharmaceuticals.

Peer reviewers

Juliet C Gray, MB, BS, MA, MRCPCH, PhD

Associate Professor and Consultant in Paediatric Oncology

University of Southampton

Southampton

UK

Disclosures

JCG declares that she has no competing interests.

Daniel Weiser, MD

Medical Director, Intra-Abdominal Solid Tumor Program

Children's Hospital at Montefiore

Assistant Professor, Departments of Pediatrics & Genetics

Albert Einstein College of Medicine

Bronx

NY

Disclosures

DW declares that he has no competing interests.

David Ziegler, MBBS, BSc (Med), FRACP, MD/PhD

Senior Staff Specialist

Sydney Children’s Hospital

Randwick

Sydney

Australia

Disclosures

DZ declares that he has no competing interests.

Use of this content is subject to our disclaimer