Neuroblastoma

A young child with a firm abdominal mass, unexplained hypertension, bone pain, or a new limp may have neuroblastoma. The finding that changes urgency is not the mass alone but what it is doing: compressing the airway or spinal cord, impairing organ function, infiltrating marrow, or causing treatment-related metabolic instability. Neuroblastoma can look different from one child to another because the tumour follows sympathetic nervous system tissue and may spread early. A cervical or thoracic tumour can cause respiratory or swallowing symptoms; an abdominal or adrenal tumour can cause distention and feeding difficulty; paraspinal disease can threaten neurologic function. Periorbital bruising, proptosis, pallor, bruising, or refusal to walk should prompt a search for metastatic disease rather than being dismissed as isolated childhood complaints.