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Symptoms of solid tumors outside the CNS

Child with increased abdominal circumference from a Wilms` tumor in the left kidney. Click to enlarge the image.
The most common initial symptoms of a tumor in the abdomen include pain, increased abdominal circumference, and reduced general health status. Nevertheless, large tumors are sometimes found in nearly completely healthy children.  

Other symptoms may include:

  • hematuria
  • constipation/diarrhea
  • dyspnea
  • venous obstruction
  • liver enlargement
  • involuntary movements (ataxia, opsoclonus myoclonus syndrome)
  • hematological disturbances (anemia, thrombocytopenia)
  • hypertension
  • hormone disturbances (for example precocious puberty)

Rhabdomyosarcoma and NRSTS

How and how early these tumors are discovered depends on localization and growth rate. Typically, the tumor is asymptomatic and is found by coincidence. The tumor is accompanied by pain or other signs of illness if there is venous or lymphatic obstruction, invasion of neighboring organs, or distant metastasis. Non-rhabdo soft tissue sarcoma occurs usually in the extremities, abdominal cavity/chest wall, or retroperitoneum. In the case of NRSTS, invasion of local lymph nodes is present in only 10% of patients and metastases occur in only 10-12%.  


Patients with osteosarcoma often do not have obvious symptoms until late in the disease course. These patients contact their doctor usually for intermittent pain that usually develops into constant pain. The pain is often thought to be due to a trauma. Tumor-related swelling and loss of function in neighboring joints usually follows. In about 10% of cases, the first sign of illness is a pathological fracture. Bone pain in other locations than the primary tumor may be due to metastases. 

The most common location for metastases is the lungs. Lung metastases do not cause symptoms difficulty until there are extensive changes.

Fever and weight loss are observed only in advanced stages.

Ewing's sarcoma and pPNET

Patients with Ewing's sarcoma and pNET usually contact a doctor for pain. Additional symptoms depend on the location and size of the tumor. Pain is often misinterpreted as a result of injury, but usually lasts unusually long. Lasting and increasing pain followed by swelling of the affected area can be misinterpreted as an infection thereby delaying the correct diagnosis.  

Invasion of bone marrow or peripheral nerves can cause neurological symptoms. Bone metastasis can be palpated on the skull, rib bones, or other superficial bones.

Mild to moderate fever is reported in about one third of these patients and occurs more frequently in those with metastasis at the time of the diagnosis.


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