This depends on the site of the tumour and the organ it is pressing on. In the posterior mediastinum it may cause respiratory difficulties, while in the pelvis it can cause bowel or bladder dysfunction. Disseminated disease accounts for 50% of patients at the time they present. The spread of the disease is associated with symptoms such as pallor, anorexia and changes in personality. When the tumour arises in the paravertebral sympathetic chain it can infiltrate the intervertebral foramina. This may occur in up to 10% of patients, and can become a serious complication if undetected, as it can lead to cord compression and paraplegia.