Paraneoplastic syndrome: Difference between revisions
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'''PCFor patient information, click [[Paraneoplastic syndrome (patient information)|here]]''' | '''PCFor patient information, click [[Paraneoplastic syndrome (patient information)|here]]''' | ||
{{Paraneoplastic syndrome}} | {{Paraneoplastic syndrome}} | ||
{{CMG}} ; {{AE}} {{G.D.}} | {{CMG}} ; {{AE}} {{G.D.}} | ||
{{SK}} Paraneoplastic syndrome | {{SK}} Paraneoplastic syndrome | ||
==Overview== | ==Overview== | ||
'''Paraneoplastic syndromes''' are a rare type of [[diseases|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 [[Malignant|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 [[Endocrine|endocrines]]. They are no cures for the paraneoplastic syndrome, but [[cancer]] treatment and some [[medications]] to reduce [[Autoimmunity|autoimmune]] responses are helpful. | '''Paraneoplastic syndromes''' are a rare type of [[diseases|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 [[Malignant|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 [[Endocrine|endocrines]]. They are no cures for the paraneoplastic syndrome, but [[cancer]] treatment and some [[medications]] to reduce [[Autoimmunity|autoimmune]] responses are helpful. | ||
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| align="center" style="background:#4479BA; color: #FFFFFF;" |'''Associated Cancers''' | | align="center" style="background:#4479BA; color: #FFFFFF;" |'''Associated Cancers''' | ||
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| rowspan="5" align="center" style="background:#f0f0f0;" |[[Endocrine|Endocrine metabolic]] [[Syndrome|syndromes]] | | rowspan="5" align="center" style="background:#f0f0f0;" |[[Endocrine|Endocrine metabolic]] [[Syndrome|syndromes]]</ref><ref name="pmid15673803">{{cite journal |vauthors=Stewart AF |title=Clinical practice. Hypercalcemia associated with cancer |journal=N. Engl. J. Med. |volume=352 |issue=4 |pages=373–9 |date=January 2005 |pmid=15673803 |doi=10.1056/NEJMcp042806 |url=}}</ref><ref name="pmid16337807">{{cite journal |vauthors=Spinazzé S, Schrijvers D |title=Metabolic emergencies |journal=Crit. Rev. Oncol. Hematol. |volume=58 |issue=1 |pages=79–89 |date=April 2006 |pmid=16337807 |doi=10.1016/j.critrevonc.2005.04.004 |url=}}</ref> | ||
|[[Hypercalcemia]] | |[[Hypercalcemia]] | ||
|[[breast cancer]] and [[lung cancer]] (typically [[Squamous cell carcinoma|squamous cell]]) due to the production of [[Parathyroid hormone-related protein|PTHrP]] ([[Parathyroid hormone]]-related [[protein]])[[multiple myeloma]], [[renal cell carcinoma]], [[ovarian cancer]], [[endometrial cancer]], and [[lymphoma]] | |[[breast cancer]] and [[lung cancer]] (typically [[Squamous cell carcinoma|squamous cell]]) due to the production of [[Parathyroid hormone-related protein|PTHrP]] ([[Parathyroid hormone]]-related [[protein]])[[multiple myeloma]], [[renal cell carcinoma]], [[ovarian cancer]], [[endometrial cancer]], and [[lymphoma]] | ||
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|[[Syndrome of inappropriate antidiuretic hormone|SIADH]]||[[small cell lung cancer]], [[mesothelioma]], [[breast]], [[prostate]], [[adrenal]], [[urethral]], [[thymoma]], [[lymphoma]], GI, CNS, and [[Ewing sarcoma]] | |[[Syndrome of inappropriate antidiuretic hormone|SIADH]]<ref name="pmid17701059">{{cite journal |vauthors=Raftopoulos H |title=Diagnosis and management of hyponatremia in cancer patients |journal=Support Care Cancer |volume=15 |issue=12 |pages=1341–7 |date=December 2007 |pmid=17701059 |doi=10.1007/s00520-007-0309-9 |url=}}</ref><ref name="pmid17507705">{{cite journal |vauthors=Ellison DH, Berl T |title=Clinical practice. The syndrome of inappropriate antidiuresis |journal=N. Engl. J. Med. |volume=356 |issue=20 |pages=2064–72 |date=May 2007 |pmid=17507705 |doi=10.1056/NEJMcp066837 |url=}}</ref>||[[small cell lung cancer]], [[mesothelioma]], [[breast]], [[prostate]], [[adrenal]], [[urethral]], [[thymoma]], [[lymphoma]], GI, CNS, and [[Ewing sarcoma]] | ||
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|[[Hypoglycemia]] | |[[Hypoglycemia]]<ref name="pmid9876347">{{cite journal |vauthors=Teale JD, Marks V |title=Glucocorticoid therapy suppresses abnormal secretion of big IGF-II by non-islet cell tumours inducing hypoglycaemia (NICTH) |journal=Clin. Endocrinol. (Oxf) |volume=49 |issue=4 |pages=491–8 |date=October 1998 |pmid=9876347 |doi= |url=}}</ref> | ||
|[[Gastrointestinal tract|GI]] cancers, [[mesothelioma]], [[lung]], and [[sarcomas]] | |[[Gastrointestinal tract|GI]] cancers, [[mesothelioma]], [[lung]], and [[sarcomas]] | ||
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| rowspan="6" align="center" style="background:#f0f0f0;" |[[Mucocutaneous|Musculocutaneous]] paraneoplastic syndromes | | rowspan="6" align="center" style="background:#f0f0f0;" |[[Mucocutaneous|Musculocutaneous]] paraneoplastic syndromes <ref name="pmid9208889">{{cite journal |author=Cohen PR, Kurzrock R |title=Mucocutaneous paraneoplastic syndromes |journal=Semin. Oncol. |volume=24 |issue=3 |pages=334–59 |year=1997 |pmid=9208889 |doi=}}</ref> | ||
|[[Dermatomyositis]] | |[[Dermatomyositis]] | ||
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| rowspan="11" align="center" style="background:#f0f0f0;" |[[Neurological]] paraneoplastic syndromes | | rowspan="11" align="center" style="background:#f0f0f0;" |[[Neurological]] paraneoplastic syndromes<ref>{{MeshName|Nervous+system+paraneoplastic+syndromes}}</ref><ref name="pmid19620862">{{cite journal |vauthors=Didelot A, Honnorat J |title=Update on paraneoplastic neurological syndromes |journal=Curr Opin Oncol |volume=21 |issue=6 |pages=566–72 |date=November 2009 |pmid=19620862 |doi=10.1097/CCO.0b013e3283306647 |url=}}</ref> | ||
|[[Paraneoplastic cerebellar degeneration]] | |[[Paraneoplastic cerebellar degeneration]] | ||
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|[[Encephalitis]]||[[teratoma]] | |[[Encephalitis]]<ref name="pmid17262855">{{cite journal |author=Dalmau J, Tüzün E, Wu HY, ''et al'' |title=Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma |journal=Ann. Neurol. |volume=61 |issue=1 |pages=25–36 |year=2007 |month=January |pmid=17262855 |pmc=2430743 |doi=10.1002/ana.21050 |url=}}</ref>||[[teratoma]] | ||
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|[[Polymyositis]] | |[[Polymyositis]] | ||
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| rowspan="4" align="center" style="background:#f0f0f0;" |[[Hematological]] paraneoplastic syndromes | | rowspan="4" align="center" style="background:#f0f0f0;" |[[Hematological]] paraneoplastic syndromes <ref name="pmid9208888">{{cite journal |author=Staszewski H |title=Hematological paraneoplastic syndromes |journal=Semin. Oncol. |volume=24 |issue=3 |pages=329–33 |year=1997 |pmid=9208888 |doi=}}</ref><ref name="pmid8400277">{{cite journal |vauthors=Blay JY, Favrot M, Rossi JF, Wijdenes J |title=Role of interleukin-6 in paraneoplastic thrombocytosis |journal=Blood |volume=82 |issue=7 |pages=2261–2 |date=October 1993 |pmid=8400277 |doi= |url=}}</ref> | ||
|[[Granulocytosis]] | |[[Granulocytosis]] | ||
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Revision as of 19:37, 11 October 2019
PCFor patient information, click here
|
Paraneoplastic syndrome Microchapters |
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:
- Endocrine metabolic syndromes:
- Hypercalcemia in breast cancer and lung cancer (typically squamous cell) due to the production of PTHrP (Parathyroid hormone-related protein)
- Seen also in multiple myeloma, renal cell carcinoma, ovarian cancer, endometrial cancer, and lymphoma
- SIADH
- Associated cancers: small cell lung cancer, mesothelioma, breast, prostate, adrenal, urethral, thymoma, lymphoma, GI, CNS, and Ewing sarcoma
- Ectopic ACTH secretion associated with small-cell lung cancer, carcinoid tumor, thymoma and other cancers
- Tumor induced osteomalacia
- Hypoglycemia
- Associated cancers: GI, mesothelioma, lung, and sarcomas
- Hypercalcemia in breast cancer and lung cancer (typically squamous cell) due to the production of PTHrP (Parathyroid hormone-related protein)
- Musculocutaneous paraneoplastic syndromes
- Dermatomyositis (25-50% of adult patients have an underlying malignancy)
- Leser-Trélat sign, a sudden onset of many pigmented skin lesions.
- Associated cancers: gastrointestinal adenocarcinomas (gastric, colon, rectal), breast cancer, and lymphoproliferative disorders/lymphoma, melanoma, and etc.
- Acanthosis nigricans, seen in gastric adenocarcinoma, endometrial cancer, and etc.
- Necrolytic migratory erythema which may be seen in pancreatic tumor.
- Sweet's syndrome, most commonly associated with acute myeloid leukemia or another hematologic malignancy.
- Pyoderma gangrenosum is associated with Squamous cell carcinoma, cutaneous lymphoma.
- Neurological paraneoplastic syndromes:
- Paraneoplastic cerebellar degeneration associated with lung, ovarian, breast, lymphatic, and other cancers
- Encephalomyelitis (inflammation of the brain and spinal cord)
- Limbic encephalitis
- Brainstem encephalitis
- Opsoclonus (involving eye movement)
- Encephalitis triggered by a teratoma
- Polymyositis
- Lambert-Eaton myasthenic syndrome (LEMS) in small-cell lung cancer
- Myasthenia gravis
- Subacute (peripheral) sensory neuropathy
- Autonomic neuropathy
- Hematological paraneoplastic syndromes
- Granulocytosis (increased granulocytes) due to the production of G-CSF
- Eosinophilia
- Pure red cell aplasia
- Thrombocytosis
- Others:
- Endocrine metabolic syndromes:
Causes
Common Causes
- The major causes of paraneoplastic syndrome include:
Causes by Organ System
- Paraneoplastic syndromes causes may be regrouped by organ system.
| Dermatologic | |
| Ear Nose Throat | |
| Endocrine | |
| Gastroenterologic |
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| Hematologic | |
| Musculoskeletal/Orthopedic | |
| Neurologic | |
| Obstetric/Gynecologic | |
| Oncologic | |
| Pulmonary | |
| Renal/Electrolyte | |
| Rheumatology/Immunology/Allergy |
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| 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 | |||||||||||
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| Symptoms | Physical examination | ||||||||||||||
| Lab Findings | Imaging | Histopathology | |||||||||||||
| Small cell lung cancer |
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| Squamous lung cancer |
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| Hepatocellular carcinoma |
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| 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 |
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| Renal cancer |
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| Pancreatic cancer |
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| Gastric cancer |
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| Lymphoma | _ |
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| Ovarian cancer |
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References
- ↑ Stewart AF (January 2005). "Clinical practice. Hypercalcemia associated with cancer". N. Engl. J. Med. 352 (4): 373–9. doi:10.1056/NEJMcp042806. PMID 15673803.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Cohen PR, Kurzrock R (1997). "Mucocutaneous paraneoplastic syndromes". Semin. Oncol. 24 (3): 334–59. PMID 9208889.
- ↑ Nervous+system+paraneoplastic+syndromes at the US National Library of Medicine Medical Subject Headings (MeSH)
- ↑ 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.
- ↑ 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) - ↑ Staszewski H (1997). "Hematological paraneoplastic syndromes". Semin. Oncol. 24 (3): 329–33. PMID 9208888.
- ↑ Blay JY, Favrot M, Rossi JF, Wijdenes J (October 1993). "Role of interleukin-6 in paraneoplastic thrombocytosis". Blood. 82 (7): 2261–2. PMID 8400277.