Paraneoplastic syndromes
Background
- Syndrome associated with cancer, but not due to direct, local effects of neoplasm
- Result of hormones/substances secreted by malignant cells or immune response to cancer cells/products
Examples
| Syndrome | Main causal cancers | Mechanism |
| Cushing syndrome | Small cell lung cancer, pancreatic carcinoma, neural tumors, thymoma | Ectopic ACTH/ACTH-like substance production |
| SIADH | Small cell lung cancer, CNS malignancies | Ectopic ADH production |
| Hypercalcemia | Lung (esp. SCC), breast, renal/bladder, ovarian, multiple myeloma, adult T cell leukemia/lymphoma, squamous cell carcinoma | |
| Hypoglycemia | Sarcomas, insulinoma, hepatocellular carcinoma | Insulin/IGF production |
| Carcinoid syndrome | Bronchial adenoma, pancreatic and gastric carcinoma | Serotonin or bradykinin production |
| Hyperaldosteronism | Adrenal adenoma, non-Hodgkin's lymphoma, ovarian carcinoma, lung cancer | increased/ectopic aldosterone production |
| Lambert-Eaton myasthenic syndrome | Small cell lung cancer | Immune-mediated |
| Paraneoplastic cerebellar degeneration | Lung, ovarian, breast cancers, Hodgkin's lymphoma | |
| Opsoclonus myoclonus syndrome | Neuroblastoma (occurs in 2-3% of peds cases), breast, ovarian, small-cell carcinoma | Autoimmune; s/sx include opsoclonus/myoclonus and other cerebellar dysfunction, aphasia, lethargy/irritability |
| Brain-stem or limbic encephalitis | Small cell lung cancer, germ-cell testicular tumors | Autoantibodies against intracellular neuronal proteins |
| Anti-NMDA receptor encephalitis | Gyn tumors (esp. teratomas) | Anti-NMDA receptor auto-antibodies |
| Polymyositis/Dermatomyositis | Lymphoma, lung, pancreatic, stomach, bladder, ovarian | autoimmune |
| Acanthosis nigricans | Gastric, lung, uterine | Epidermal growth factor secretion |
| Misc. derm conditions (Sweet's syndrome, Leser-Trelat sign, pyoderma gangrenosum, florid cutaneous papillomatosis, necrolytic migratory erythema, hypertrichosis) | lung, GI adenocarcinomas, breast and GU cancers, lymphoma | |
| VTE, thrombophlebitis | any advanced cancer. Pancreatic and bronchogenic carcinomas associated w/trousseau's sign | Hypercoagulability |
| Polycythemia | Renal cell carcinoma, cerebellar hemangioma, hepatocellular carcinoma | Increased erythropoietin production |
| Granulocytosis | various | C-GSF |
| Membranous glomerulonephritis | tumor antigens/immune complexes | |
| Thymoma-associated multiorgan autoimmunity | Thymoma | similar to GVHD |
References
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