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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pancreatic cancer]]<ref name="pmid19129613">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }}</ref><ref name="pmid15960930">{{cite journal| author=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A et al.| title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. | journal=Clin Transl Oncol | year= 2005 | volume= 7 | issue= 5 | pages= 189-97 | pmid=15960930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15960930  }}</ref><ref name="HollyChaliha2004">{{cite journal|last1=Holly|first1=Elizabeth A.|last2=Chaliha|first2=Indranushi|last3=Bracci|first3=Paige M.|last4=Gautam|first4=Manjushree|title=Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area|journal=Clinical Gastroenterology and Hepatology|volume=2|issue=6|year=2004|pages=510–517|issn=15423565|doi=10.1016/S1542-3565(04)00171-5}}</ref><ref name="pmid26495795">{{cite journal| author=Schmidt-Hansen M, Berendse S, Hamilton W| title=Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review. | journal=Pancreas | year= 2016 | volume= 45 | issue= 6 | pages= 814-8 | pmid=26495795 | doi=10.1097/MPA.0000000000000527 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26495795  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pancreatic cancer]]<ref name="pmid19129613">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }}</ref><ref name="pmid15960930">{{cite journal| author=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A et al.| title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. | journal=Clin Transl Oncol | year= 2005 | volume= 7 | issue= 5 | pages= 189-97 | pmid=15960930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15960930  }}</ref><ref name="HollyChaliha2004">{{cite journal|last1=Holly|first1=Elizabeth A.|last2=Chaliha|first2=Indranushi|last3=Bracci|first3=Paige M.|last4=Gautam|first4=Manjushree|title=Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area|journal=Clinical Gastroenterology and Hepatology|volume=2|issue=6|year=2004|pages=510–517|issn=15423565|doi=10.1016/S1542-3565(04)00171-5}}</ref><ref name="pmid26495795">{{cite journal| author=Schmidt-Hansen M, Berendse S, Hamilton W| title=Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review. | journal=Pancreas | year= 2016 | volume= 45 | issue= 6 | pages= 814-8 | pmid=26495795 | doi=10.1097/MPA.0000000000000527 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26495795  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |Mid-epigastric pain, nausea, jaundice, dark urine
| style="background: #F5F5F5; padding: 5px;" |Mid-[[epigastric]] [[pain]]
| style="background: #F5F5F5; padding: 5px;" |Weight loss, abdominal pain
[[Nausea]][[Jaundice]]
| style="background: #F5F5F5; padding: 5px;" |Anorexia, greasy stools, Asthenia,
 
| style="background: #F5F5F5; padding: 5px;" |Cachexia, migratory superficial thrombophlebitis on the skin
[[Dark urine]]
| style="background: #F5F5F5; padding: 5px;" |Abdominal distention and tenderness, left Supraclavicular lymphadenopathy
| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]] [[Abdominal pain]]
| style="background: #F5F5F5; padding: 5px;" |Palpable periumbilical mass
| style="background: #F5F5F5; padding: 5px;" |[[Anorexia]] [[Greasy stools]] [[Asthenia]]
| style="background: #F5F5F5; padding: 5px;" |↑ bilirubin
| style="background: #F5F5F5; padding: 5px;" |[[Cachexia]]
| style="background: #F5F5F5; padding: 5px;" |↑ ALP
Migratory superficial [[thrombophlebitis]] on the [[skin]]
↑ LFT
| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] distention and tenderness
Left [[Supraclavicular]] [[lymphadenopathy]]
| style="background: #F5F5F5; padding: 5px;" |[[Palpable|Palpable periumbilical]] [[mass]]
| style="background: #F5F5F5; padding: 5px;" |↑ [[bilirubin]]
| style="background: #F5F5F5; padding: 5px;" |↑ [[ALP]]
↑ [[LFT]]
| style="background: #F5F5F5; padding: 5px;" |Low albumin and cholesterol
| style="background: #F5F5F5; padding: 5px;" |Low albumin and cholesterol
| style="background: #F5F5F5; padding: 5px;" |Abdominal Ct scan: Pancreatic duct dilation, pancreatic atrophy, obstuction of common bile duct
| style="background: #F5F5F5; padding: 5px;" |Abdominal Ct scan: Pancreatic duct dilation, pancreatic atrophy, obstuction of common bile duct

Revision as of 15:20, 12 August 2019

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

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor. Sometimes the symptoms of paraneoplastic syndromes show even before the diagnosis of a malignancy.

Classification

Paraneoplastic syndromes can be divided into 4 main categories:

Causes

Common Causes

The major causes of paraneoplastic syndrome include:[13][14][15]

Causes by Organ System

Dermatologic Dermatomyositis, Cutaneous T-cell lymphoma
Ear Nose Throat Oropharyngeal cancer
Endocrine Medullary thyroid cancer, Adrenal cancer
Gastroenterologic Pancreatic cancer, Other GI cancers
Hematologic Myeloproliferative disorders, Myeloma, Melanoma, Lymphoma, HTLV-associated Lymphoma, Hodgkin's lymphoma, Chronic lymphocytic leukemia, Cancers of the T-cells , Adult T-cell leukemia, Acute myeloid leukemia,
Musculoskeletal/Orthopedic Teratoma, Sarcomas, Ewing sarcoma
Neurologic Brain Cancer
Obstetric/Gynecologic ovarian cancer, Endometrial cancer
Oncologic Breast cancer
Pulmonary Small cell lung cancer, Pancoast's tumour, Oat cell carcinoma, Non-small cell lung cancer, Malignant Mesothelioma, Bronchial carcinoid
Renal/Electrolyte Kidney cancer
Rheumatology/Immunology/Allergy No underlying causes
Urologic Ureteral cancer, Prostate cancer, Bladder cancer
Miscellaneous Thymoma, Testicular germ-cell tumors

Differential diagnosis

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Small cell lung cancer[16][17] Cough

Weakness

Weight loss

Fatigue

Dyspnea

GI symptoms

Lymphadenopathy

Dehydration

Decrease air entry in the lungs

Digital clubbing

Bone tenderness ↑ Ca++ Hyponatremia - Chest Ct Scan: Necrotic and hemorrhagic hilar mass, Lymphadenopathy Chest X-ray: hilar mass - Small, round and oval cells.

Necrotic

Biopsy
Squamous lung cancer[18] Asymptomatic in early onset Chronic Cough, Dyspnea Weight loss, Fatigue, hemoptysis Confused,

Lymphadenopathy

Fingers clubbing,

Weakness,

Decreased breath sound - ↑ Ca++ - - Chest Ct scan : Ground glass opacity Chest X-ray: Spiculated Mass, bulky hilum - Intracellular bridges, central necrosis with cavitation Biopsy
Hepatocellular carcinoma[19][20] Asymptomatic in early onset. Fatigue, Abdominal pain, Nausea, Vomiting, Fever Loss of appetite, Pruritus, Jaundice Jaundice

Cachexia

Ascites

Splenomegaly - Prolong PT ↑ alpha fetoprotein - - - Biopsy -
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[21][22][23] Lump in the breast

Nipple discharge

Bone pain Weight loss Loss of appetite Shortness of breath Enlarged Supraclavicular lymph nodes Dimpling of skin Inverted nipples Bloody nipple discharge, Change in personality - - - Mammogram: Soft tissue mass

Microcalcification

- - Biopsy
Renal cancer[24][25][26][27] Hematuria

Flank pain

Weight loss

Anorexia

Abdominal mass Fatigue Cachexia

Abdominal bruit Palpable abdominal mass

Supraclavicular lymphadenopathy High blood pressure

Pallor

↑ ca++ Polycythemia ↑ platelets ↑ ALP

↑ LFT

↑ LDH

↑ creatinine ↑ cancer cells in urine cytology Abdominal CT scan: Thickened irregular walls, neoplastic mass - - Depending on the subtypes. Needle Biopsy
Pancreatic cancer[28][29][30][31] Mid-epigastric pain

NauseaJaundice

Dark urine

Weight loss Abdominal pain Anorexia Greasy stools Asthenia Cachexia

Migratory superficial thrombophlebitis on the skin

Abdominal distention and tenderness

Left Supraclavicular lymphadenopathy

Palpable periumbilical mass ↑ bilirubin ↑ ALP

↑ LFT

Low albumin and cholesterol Abdominal Ct scan: Pancreatic duct dilation, pancreatic atrophy, obstuction of common bile duct - U/S: hypoechoic mass Nuclei are small and pleomorphic

Granular cytoplasm

Spiral CT scan with contrast
Gastric cancer[32][33][34][35] History of gastric ulcer, early satiety, hematemesis

Diffuse seborrheic keratosis

Weight loss, lost of appetite Dysphagia, abdominal discomfort, Palpable abdominal mass Left supraclavicular lymphadenopathy - ↑ CA 19-9

Anemia

 - - Abdominal CT scan: thickened gastric wall

Loss of rugal fold

mucosal irregularity, ulcerative lesion

- Endoscopy: Ulcer Irregular tubular structure, minimal stroma, and cellular pleomorphism, nucleus located at the periphery Endoscopy and biopsy Microangiopathic hemolytic anemia

Hypercogulable state

Menbranous nephropathy

Polyarteritis nodosa, Acanthosis nigricans

Lymphoma[36][37] Weight loss

Abdominal pain

Fever, Fatigue Night sweat Lymphadenopathy, hepatosplenomegaly - - ↑ ESR

↑ LDH

- - Ct scan of abdomen, pelvic, and chest: for metastasis to distant organs. - - It depends on the type of lymphoma Biopsy
Ovarian cancer[38][39] Asymptomatic in early onset, unexplained thromboses Abdominal pain, bloating, distended Early satiety, increase of urinary frequency and urgency Palpable adnexal mass, ascites, pleural effusion Legs swelling and tenderness Diminish breath sound from the effusion ↑ CA-125 and Ca++ - - Pelvic U/S: Solid irregular mass, irregular thick septation Abdominal Ct scan: findings depend on the subtypes - Nuclear pleomorphism, macronucleolus, eccentric nucleus, psammoma bodies, necrosis - Trousseau syndrome

References

  1. ↑ Cohen PR, Kurzrock R (1997). "Mucocutaneous paraneoplastic syndromes". Semin. Oncol. 24 (3): 334–59. PMID 9208889.
  2. ↑ Nervous+system+paraneoplastic+syndromes at the US National Library of Medicine Medical Subject Headings (MeSH)
  3. ↑ Didelot A, Honnorat J (November 2009). "Update on paraneoplastic neurological syndromes". Curr Opin Oncol. 21 (6): 566–72. doi:10.1097/CCO.0b013e3283306647. PMID 19620862.
  4. ↑ Dalmau J, Tüzün E, Wu HY; et al. (2007). "Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma". Ann. Neurol. 61 (1): 25–36. doi:10.1002/ana.21050. PMC 2430743. PMID 17262855. Unknown parameter |month= ignored (help)
  5. ↑ Staszewski H (1997). "Hematological paraneoplastic syndromes". Semin. Oncol. 24 (3): 329–33. PMID 9208888.
  6. ↑ Blay JY, Favrot M, Rossi JF, Wijdenes J (October 1993). "Role of interleukin-6 in paraneoplastic thrombocytosis". Blood. 82 (7): 2261–2. PMID 8400277.
  7. ↑ Paraneoplastic+endocrine+syndromes at the US National Library of Medicine Medical Subject Headings (MeSH)
  8. ↑ Stewart AF (January 2005). "Clinical practice. Hypercalcemia associated with cancer". N. Engl. J. Med. 352 (4): 373–9. doi:10.1056/NEJMcp042806. PMID 15673803.
  9. ↑ Spinazzé S, Schrijvers D (April 2006). "Metabolic emergencies". Crit. Rev. Oncol. Hematol. 58 (1): 79–89. doi:10.1016/j.critrevonc.2005.04.004. PMID 16337807.
  10. ↑ Raftopoulos H (December 2007). "Diagnosis and management of hyponatremia in cancer patients". Support Care Cancer. 15 (12): 1341–7. doi:10.1007/s00520-007-0309-9. PMID 17701059.
  11. ↑ Ellison DH, Berl T (May 2007). "Clinical practice. The syndrome of inappropriate antidiuresis". N. Engl. J. Med. 356 (20): 2064–72. doi:10.1056/NEJMcp066837. PMID 17507705.
  12. ↑ Teale JD, Marks V (October 1998). "Glucocorticoid therapy suppresses abnormal secretion of big IGF-II by non-islet cell tumours inducing hypoglycaemia (NICTH)". Clin. Endocrinol. (Oxf). 49 (4): 491–8. PMID 9876347.
  13. ↑ Richardson GE, Johnson BE (1992). "Paraneoplastic syndromes in lung cancer". Curr Opin Oncol. 4 (2): 323–33. PMID 1591305.
  14. ↑ Gold PJ, Fefer A, Thompson JA (1996). "Paraneoplastic manifestations of renal cell carcinoma". Semin Urol Oncol. 14 (4): 216–22. PMID 8946620.
  15. ↑ 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.
  16. ↑ NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ 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.
  26. ↑ Laski ME, Vugrin D (1987). "Paraneoplastic syndromes in hypernephroma". Semin Nephrol. 7 (2): 123–30. PMID 3306861.
  27. ↑ 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.
  28. ↑ 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.
  29. ↑ 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.
  30. ↑ 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.
  31. ↑ 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.
  32. ↑ 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.
  33. ↑ 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.
  34. ↑ 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.
  35. ↑ 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.
  36. ↑ Hagler KT, Lynch JW (2004). "Paraneoplastic manifestations of lymphoma". Clin Lymphoma. 5 (1): 29–36. PMID 15245605.
  37. ↑ 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.
  38. ↑ Hippisley-Cox J, Coupland C (2011). "Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm". BMJ. 344: d8009. doi:10.1136/bmj.d8009. PMC 3251328. PMID 22217630.
  39. ↑ 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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