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Last reviewed: 26 Jul 2025
Last updated: 17 Jun 2025

Summary

Definition

History and exam

Key diagnostic factors

  • age ≤4 years
  • abdominal distension
  • abdominal mass
  • pain
  • decreased appetite
  • weight loss
  • fussiness (infants)
  • fatigue
  • periorbital ecchymosis (raccoon eyes)
  • subcutaneous skin nodules
  • family history of neuroblastic tumors
  • signs of spinal cord compression
  • signs of Horner syndrome
  • signs of superior vena cava syndrome
  • intractable secretory diarrhea
  • opsoclonus-myoclonus ataxia (OMA)

Other diagnostic factors

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

Risk factors

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

Diagnostic tests

1st tests to order

  • CBC
  • serum electrolytes
  • serum creatinine/BUN
  • LFTs
  • urine catecholamines
  • ultrasound abdomen
  • CT scan
  • MRI scan
  • tumor biopsy

Tests to consider

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

Treatment algorithm

Contributors

Authors

Associate Professor

University of Massachusetts

Chan Medical School

Worcester

MA

Disclosures

JS is an author of a reference cited in the topic.

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 US WorldMeds. JF is an author of references cited in the topic.

Peer reviewers

Associate Professor and Consultant in Paediatric Oncology

University of Southampton

Southampton

UK

Disclosures

JCG declares that she has no competing interests.

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.

Assistant Professor of Pediatrics

Nationwide Children's Hospital

The Ohio State University

Columbus

OH

Disclosures

KS is a consultant for YmAbs Therapeutics, Inc, Amgen, and Illumina Radiopharmaceuticals, Inc.

Senior Staff Specialist

Sydney Children’s Hospital

Randwick

Sydney

Australia

Disclosures

DZ declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Brisse HJ, McCarville MB, Granata C, et al. Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project. Radiology. 2011 Oct;261(1):243-57.Full text  Abstract

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: neuroblastoma [internet publication].Full text

Park JR, Bagatell R, Cohn SL, et al. Revisions to the International Neuroblastoma Response Criteria: a consensus statement from the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol. 2017 Aug 1;35(22):2580-7.Full text  Abstract

Irwin MS, Naranjo A, Zhang FF, et al. Revised neuroblastoma risk classification system: a report from the Children's Oncology Group. J Clin Oncol. 2021 Oct 10;39(29):3229-41. Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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