Paraneoplastic syndrome
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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
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:
- Mucocutaneous paraneoplastic syndromes [1]
- Dermatomyositis (25-50% of adult patients have an underlying malignancy)
- Leser-Trélat sign, a sudden onset of many pigmented skin lesions
- Acanthosis nigricans
- Necrolytic migratory erythema
- Sweet's syndrome
- Pyoderma gangrenosum
- Neurological paraneoplastic syndromes [2][3]
- 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[4]
- Polymyositis
- Lambert-Eaton myasthenic syndrome (LEMS) in small-cell lung cancer
- Myasthenia gravis
- Subacute (peripheral) sensory neuropathy
- Autonomic neuropathy
- Hematological paraneoplastic syndromes [5][6]
- Granulocytosis (increased granulocytes) due to the production of G-CSF
- Eosinophilia
- Pure red cell aplasia
- Thrombocytosis
- Endocrine metabolic syndromes[7][8][9]
- Hypercalcemia in breast cancer and lung cancer (typically squamous cell) due to the production of PTHrP (Parathyroid hormone-related protein)
- Seen in multiple myeloma, renal cell carcinoma, ovarian cancer, endometrial cancer, and lymphoma
- SIADH[10][11]
- 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[12]
- 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)
- Others that may not fit into any of the above categories include:
Causes
Common Causes
The major causes of paraneoplastic syndrome include:
- Small cell lung cancer
- Non-small cell lung cancer
- Myeloma
- Breast cancer
- Medullary thyroid cancer
- Bronchial carcinoid
- Pancoast's tumour
- Pancreatic cancer
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 | |||||||||||||
| Weight loss | Fever | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | ||||||||
| Small cell lung cancer | |||||||||||||||
| Squamous lung cancer | |||||||||||||||
| Hepatocellular carcinoma | |||||||||||||||
| 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 | |||||||||||||||
| Renal cancer | |||||||||||||||
| pancreatic cancer | |||||||||||||||
References
- ↑ 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.
- ↑ Paraneoplastic+endocrine+syndromes at the US National Library of Medicine Medical Subject Headings (MeSH)
- ↑ 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.