Symptoms:

The first symptoms are usually fever, a general sick feeling (malaise), and pain. There may also be loss of appetite, weight loss, and diarrhea.

Other symptoms depend on the site of the tumor, and may include:

• Bone pain or tenderness (if the cancer spreads to the bones)
• Difficulty breathing or a chronic cough (if the cancer spreads to the chest)
• Enlarged abdomen (from a large tumor or excess fluid)
• Flushed, red skin
• Pale skin and bluish color around the eyes
• Profuse sweating
• Rapid pulse (tachycardia)

Brain and nervous system problems may include:

• Inability to empty the bladder
• Loss of movement (paralysis) of the hips, legs, or feet (lower extremities)
• Problems with balance
• Uncontrolled eye movements or leg and feet movements (called opsoclonus-myoconus syndrome, or "dancing eyes and dancing feet")

Signs and tests:

Signs vary depending on the location of the tumor.

• Examination of the abdomen with the hands (palpation) may reveal a lump.
• The liver may be enlarged, if the tumor has spread to the liver.
• Adrenal gland tumors can cause high blood pressure and a fast heart rate.
• Lymph nodes may be swollen.

X-ray or imaging tests are done to locate the main (primary) tumor and to see where it has spread. These include:

• Bone scan
• Bone x-rays
• Chest x-ray
• CT scan of chest and abdomen
• MRI scan of chest and abdomen

Other tests include:

• Biopsy of tumor
• Bone marrow biopsy
• CBC showing anemia or other abnormality
• Coagulation studies, erythrocyte sedimentation rate
• Hormone tests (blood tests to check levels of hormones such as epinephrine and other catecholamines)
• MIBG scan
• Urine 24-hour test for catecholamines, homovanillic acid (HVA), and vanillymandelic acid (VMA)