Paraneoplastic syndrome

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Paraneoplastic syndrome Microchapters

Patient Information

Overview

Classification

Endocrine
Musculocutaneous
Neurological
Hematological
Others

Causes

Differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]
Synonyms and keywords: Paraneoplastic syndrome

Overview

Paraneoplastic syndromes are a rare type of disease that is caused by abnormal immune systems resulting from cancerous cells. Paraneoplastic syndromes are disorders due to the release of hormones, or peptides that cause immune cross-reactivity between cancerous cells and normal tissues. Sometimes the symptoms of paraneoplastic syndromes show even before the diagnosis of a malignancy. There is no screening for paraneoplastic syndromes. The stage and type of diagnosis of cancer determine the prognosis of a paraneoplastic syndrome. The causes are mostly related to the organ affected. The paraneoplastic syndromes are divided into four main categories such as musculocutaneous, neurological, hematological and endocrines. They are no cures for the paraneoplastic syndrome, but cancer treatment and some medications to reduce autoimmune responses are helpful.

Classification

  • Paraneoplastic syndromes may be classified into 5 main categories accordingly:
Type of paraneoplastic syndrome Subtype Associated Cancers
Endocrine
Musculocutaneous
Neurological[11]
Hematological[11]
Others

Causes

Common Causes

Causes by Organ System

  • Paraneoplastic syndromes causes may be regrouped by organ system.[26][27]
Dermatologic
Ear Nose Throat
Endocrine
Gastroenterologic
Hematologic
Musculoskeletal/Orthopedic
Neurologic
Obstetric/Gynecologic
Oncologic
Pulmonary
Renal/Electrolyte
Rheumatology/Immunology/Allergy
  • No underlying causes
Urologic
Miscellaneous

Differential diagnosis

Paraneoplastic syndromes must be differentiated from others types of cancer depending on the location and type of organs.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Small cell lung cancer[28][29] _ _ Small, round and oval cells

Necrosis

Biopsy _
Squamous lung cancer[30]


_ _ _ _
Hepatocellular carcinoma[31][32] _ _ _ _
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Breast cancer[33][34][35] _ _ _ _ _ _
Renal cancer[36][37][38][39] _ _
  • Depends on the subtypes
 _
Pancreatic cancer[40][41][42][43] _
  • U/S: hypoechoic mass
 _
Gastric cancer[44][45][46][47]


_ _ _
Lymphoma][48][49] _ _ _ _
  • Depends on the type of lymphoma
 _
Ovarian cancer[50][51] _ _

References

  1. ↑ Stewart, Andrew F. (2005). "Hypercalcemia Associated with Cancer". New England Journal of Medicine. 352 (4): 373–379. doi:10.1056/NEJMcp042806. ISSN 0028-4793.
  2. ↑ Raftopoulos, Harry (2007). "Diagnosis and management of hyponatremia in cancer patients". Supportive Care in Cancer. 15 (12): 1341–1347. doi:10.1007/s00520-007-0309-9. ISSN 0941-4355.
  3. ↑ Barbosa, Sandrine Laboureau-Soares; Rodien, Patrice; Leboulleux, Sophie; Niccoli-Sire, Patricia; Kraimps, Jean-Louis; Caron, Philippe; Archambeaud-Mouveroux, Françoise; Conte-Devolx, Bernard; Rohmer, Vincent (2005). "Ectopic Adrenocorticotropic Hormone-Syndrome in Medullary Carcinoma of the Thyroid: A Retrospective Analysis and Review of the Literature". Thyroid. 15 (6): 618–623. doi:10.1089/thy.2005.15.618. ISSN 1050-7256.
  4. ↑ Florenzano, Pablo; Gafni, Rachel I.; Collins, Michael T. (2017). "Tumor-induced osteomalacia". Bone Reports. 7: 90–97. doi:10.1016/j.bonr.2017.09.002. ISSN 2352-1872.
  5. ↑ Nauck, Michael A.; Reinecke, Manfred; Perren, Aurel; Frystyk, Jan; Berishvili, Giorgi; Zwimpfer, Cornelia; Figge, Anja M.; Flyvbjerg, Allan; Lankisch, Paul G.; Blum, Werner F.; Klöppel, Günter; Schmiegel, Wolff; Zapf, Jürgen (2007). "Hypoglycemia due to Paraneoplastic Secretion of Insulin-Like Growth Factor-I in a Patient with Metastasizing Large-Cell Carcinoma of the Lung". The Journal of Clinical Endocrinology & Metabolism. 92 (5): 1600–1605. doi:10.1210/jc.2006-2573. ISSN 0021-972X.
  6. ↑ 6.0 6.1 Thiers, B. H.; Sahn, R. E.; Callen, J. P. (2009). "Cutaneous Manifestations of Internal Malignancy". CA: A Cancer Journal for Clinicians. 59 (2): 73–98. doi:10.3322/caac.20005. ISSN 0007-9235.
  7. ↑ Gaduputi, Vinaya; Chandrala, Chaitanya; Tariq, Hassan; Kanneganti, Kalyan (2014). "Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer". Case Reports in Oncological Medicine. 2014: 1–3. doi:10.1155/2014/825929. ISSN 2090-6706.
  8. ↑ Tremblay, Catherine; Marcil, Isabelle (2017). "Necrolytic Migratory Erythema: A Forgotten Paraneoplastic Condition". Journal of Cutaneous Medicine and Surgery. 21 (6): 559–561. doi:10.1177/1203475417719051. ISSN 1203-4754.
  9. ↑ Cohen, Philip R.; Kurzrock, Razelle (1987). "Sweet's syndrome and malignancy". The American Journal of Medicine. 82 (6): 1220–1226. doi:10.1016/0002-9343(87)90229-4. ISSN 0002-9343.
  10. ↑ You, Hye Rin; Ju, Jae-Kyun; Yun, Sook Jung; Lee, Jee-Bum; Kim, Seong-Jin; Won, Young Ho; Lee, Seung-Chul (2018). "Paraneoplastic Pyoderma Gangrenosum Associated with Rectal Adenocarcinoma". Annals of Dermatology. 30 (1): 79. doi:10.5021/ad.2018.30.1.79. ISSN 1013-9087.
  11. ↑ 11.0 11.1 11.2 11.3 Pelosof, Lorraine C.; Gerber, David E. (2010). "Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment". Mayo Clinic Proceedings. 85 (9): 838–854. doi:10.4065/mcp.2010.0099. ISSN 0025-6196.
  12. ↑ Abdulaziz, Ammar Taha Abdullah; Yu, Xiao Qing; Zhang, Le; Jiang, Xin Yue; Zhou, Dong; Li, Jin Mei (2018). "Paraneoplastic cerebellar degeneration associated with cerebellar hypermetabolism". Medicine. 97 (24): e10717. doi:10.1097/MD.0000000000010717. ISSN 0025-7974.
  13. ↑ Graus, F. (2001). "Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients". Brain. 124 (6): 1138–1148. doi:10.1093/brain/124.6.1138. ISSN 1460-2156.
  14. ↑ Shen, Kaini; Xu, Yan; Guan, Hongzhi; Zhong, Wei; Chen, Minjiang; Zhao, Jing; Li, Longyun; Wang, Mengzhao (2018). "Paraneoplastic limbic encephalitis associated with lung cancer". Scientific Reports. 8 (1). doi:10.1038/s41598-018-25294-y. ISSN 2045-2322.
  15. ↑ 15.0 15.1 Blaes, Franz (2013). "Paraneoplastic Brain Stem Encephalitis". Current Treatment Options in Neurology. 15 (2): 201–209. doi:10.1007/s11940-013-0221-1. ISSN 1092-8480.
  16. ↑ Gabrilovich, Mikhail; Raza, Mohammad; Dolan, Stephen; Raza, Tasleem (2006). "Paraneoplastic Polymyositis Associated With Squamous Cell Carcinoma of the Lung". Chest. 129 (6): 1721–1723. doi:10.1378/chest.129.6.1721. ISSN 0012-3692.
  17. ↑ "Paraneoplastic autonomic neuropathy: a case report | GM".
  18. ↑ Ascensao, Joad L.; Oken, Martin M.; Ewing, Stephen L.; Goldberg, Robert J.; Kaplan, Manuel E. (1987). "Leukocytosis and large cell lung cancer. A frequent association". Cancer. 60 (4): 903–905. doi:10.1002/1097-0142(19870815)60:4<903::AID-CNCR2820600431>3.0.CO;2-6. ISSN 0008-543X.
  19. ↑ Ahn, Heui June; Park, Yeon Hee; Chang, Yoon Hwan; Park, Sun Hoo; Kim, Min-Suk; Ryoo, Baek Yeol; Yang, Sung Hyun (2005). "A Case of Uterine Cervical Cancer Presenting with Granulocytosis". The Korean Journal of Internal Medicine. 20 (3): 247. doi:10.3904/kjim.2005.20.3.247. ISSN 1226-3303.
  20. ↑ Stone, Rebecca L.; Nick, Alpa M.; McNeish, Iain A.; Balkwill, Frances; Han, Hee Dong; Bottsford-Miller, Justin; Rupaimoole, Rajesha; Armaiz-Pena, Guillermo N.; Pecot, Chad V.; Coward, Jermaine; Deavers, Michael T.; Vasquez, Hernan G.; Urbauer, Diana; Landen, Charles N.; Hu, Wei; Gershenson, Hannah; Matsuo, Koji; Shahzad, Mian M.K.; King, Erin R.; Tekedereli, Ibrahim; Ozpolat, Bulent; Ahn, Edward H.; Bond, Virginia K.; Wang, Rui; Drew, Angela F.; Gushiken, Francisca; Lamkin, Donald; Collins, Katherine; DeGeest, Koen; Lutgendorf, Susan K.; Chiu, Wah; Lopez-Berestein, Gabriel; Afshar-Kharghan, Vahid; Sood, Anil K. (2012). "Paraneoplastic Thrombocytosis in Ovarian Cancer". New England Journal of Medicine. 366 (7): 610–618. doi:10.1056/NEJMoa1110352. ISSN 0028-4793.
  21. ↑ Rosu, Cristian; Cohen, Sandra; Meunier, Caroline; Ouellette, Denise; Beauchamp, Gilles; Rakovich, George (2011). "Pure red cell aplasia and associated thymoma". Clinics and Practice. 1 (1): 1. doi:10.4081/cp.2011.e1. ISSN 2039-7283.
  22. ↑ Leeaphorn, Napat; Kue-A-Pai, Pogsathorn; Thamcharoen, Natanong; Ungprasert, Patompong; Stokes, Michael B.; Knight, Eric L. (2014). "Prevalence of Cancer in Membranous Nephropathy: A Systematic Review and Meta-Analysis of Observational Studies". American Journal of Nephrology. 40 (1): 29–35. doi:10.1159/000364782. ISSN 1421-9670.
  23. ↑ Richardson GE, Johnson BE (1992). "Paraneoplastic syndromes in lung cancer". Curr Opin Oncol. 4 (2): 323–33. PMID 1591305.
  24. ↑ Gold PJ, Fefer A, Thompson JA (1996). "Paraneoplastic manifestations of renal cell carcinoma". Semin Urol Oncol. 14 (4): 216–22. PMID 8946620.
  25. ↑ Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS (2009). "Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy". JOP. 10 (1): 37–42. PMID 19129613.
  26. ↑ Pelosof LC, Gerber DE (2010). "Paraneoplastic syndromes: an approach to diagnosis and treatment". Mayo Clin Proc. 85 (9): 838–54. doi:10.4065/mcp.2010.0099. PMC 2931619. PMID 20810794.
  27. ↑ Henry K (July 2019). "Paraneoplastic syndromes: Definitions, classification, pathophysiology and principles of treatment". Semin Diagn Pathol. 36 (4): 204–210. doi:10.1053/j.semdp.2019.01.002. PMID 30876820.
  28. ↑ NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
  29. ↑ Carter, Brett W.; Glisson, Bonnie S.; Truong, Mylene T.; Erasmus, Jeremy J. (2014). "Small Cell Lung Carcinoma: Staging, Imaging, and Treatment Considerations". RadioGraphics. 34 (6): 1707–1721. doi:10.1148/rg.346140178. ISSN 0271-5333.
  30. ↑ Rosado-de-Christenson, M L; Templeton, P A; Moran, C A (1994). "Bronchogenic carcinoma: radiologic-pathologic correlation". RadioGraphics. 14 (2): 429–446. doi:10.1148/radiographics.14.2.8190965. ISSN 0271-5333.
  31. ↑ Reynolds, Arich R.; Furlan, Alessandro; Fetzer, David T.; Sasatomi, Eizaburo; Borhani, Amir A.; Heller, Matthew T.; Tublin, Mitchell E. (2015). "Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know". RadioGraphics. 35 (2): 371–386. doi:10.1148/rg.352140114. ISSN 0271-5333.
  32. ↑ Flores, Yvonne N.; Lang, Cathy M.; Salmerón, Jorge; Bastani, Roshan (2011). "Risk Factors for Liver Disease and Associated Knowledge and Practices Among Mexican Adults in the US and Mexico". Journal of Community Health. 37 (2): 403–411. doi:10.1007/s10900-011-9457-4. ISSN 0094-5145.
  33. ↑ Mišković, Josip (2016). "DIAGNOSTIC VALUE OF FINE NEEDLE ASPIRATION CYTOLOGY FOR BREAST TUMORS". ACTA CLINICA CROATICA: 625–628. doi:10.20471/acc.2016.55.04.13. ISSN 0353-9466.
  34. ↑ Mišković J, Zorić A, Radić Mišković H, Šoljić V (2016). "Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors". Acta Clin Croat. 55 (4): 625–628. doi:10.20471/acc.2016.55.04.13. PMID 29117654.
  35. ↑ McKenna RJ (1994). "The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis". Cancer. 74 (1 Suppl): 244–55. doi:10.1002/cncr.2820741308. PMID 8004594.
  36. ↑ Cairns, Paul; Srivastava, Sudhir; Grizzle, William E. (2011). "Renal cell carcinoma". Cancer Biomarkers. 9 (1–6): 461–473. doi:10.3233/CBM-2011-0176. ISSN 1875-8592.
  37. ↑ de la Mata J, Uy HL, Guise TA, Story B, Boyce BF, Mundy GR; et al. (1995). "Interleukin-6 enhances hypercalcemia and bone resorption mediated by parathyroid hormone-related protein in vivo". J Clin Invest. 95 (6): 2846–52. doi:10.1172/JCI117990. PMC 295971. PMID 7769125.
  38. ↑ Laski ME, Vugrin D (1987). "Paraneoplastic syndromes in hypernephroma". Semin Nephrol. 7 (2): 123–30. PMID 3306861.
  39. ↑ Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
  40. ↑ Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS (2009). "Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy". JOP. 10 (1): 37–42. PMID 19129613.
  41. ↑ Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A; et al. (2005). "Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage". Clin Transl Oncol. 7 (5): 189–97. PMID 15960930.
  42. ↑ Holly, Elizabeth A.; Chaliha, Indranushi; Bracci, Paige M.; Gautam, Manjushree (2004). "Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area". Clinical Gastroenterology and Hepatology. 2 (6): 510–517. doi:10.1016/S1542-3565(04)00171-5. ISSN 1542-3565.
  43. ↑ Schmidt-Hansen M, Berendse S, Hamilton W (2016). "Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review". Pancreas. 45 (6): 814–8. doi:10.1097/MPA.0000000000000527. PMID 26495795.
  44. ↑ Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P, Denlinger C; et al. (2013). "Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines". J Natl Compr Canc Netw. 11 (5): 531–46. PMID 23667204.
  45. ↑ Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R (1993). "Cancer of the stomach. A patient care study by the American College of Surgeons". Ann Surg. 218 (5): 583–92. doi:10.1097/00000658-199321850-00002. PMC 1243028. PMID 8239772.
  46. ↑ Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM; et al. (1988). "Gastric adenocarcinoma: CT versus surgical staging". Radiology. 167 (2): 335–40. doi:10.1148/radiology.167.2.3357941. PMID 3357941.
  47. ↑ Karita M, Tada M (1994). "Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy". Gastrointest Endosc. 40 (6): 749–53. PMID 7859977.
  48. ↑ Hagler KT, Lynch JW (2004). "Paraneoplastic manifestations of lymphoma". Clin Lymphoma. 5 (1): 29–36. PMID 15245605.
  49. ↑ Briani C, Vitaliani R, Grisold W, Honnorat J, Graus F, Antoine JC; et al. (2011). "Spectrum of paraneoplastic disease associated with lymphoma". Neurology. 76 (8): 705–10. doi:10.1212/WNL.0b013e31820d62eb. PMID 21339498.
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  51. ↑ Li J, Fadare O, Xiang L, Kong B, Zheng W (2012). "Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis". J Hematol Oncol. 5: 8. doi:10.1186/1756-8722-5-8. PMC 3328281. PMID 22405464.
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