Paraneoplastic syndrome associated with gynaecological malignancy: a review of the evidence TOG 2022

Question 1

What is the incidence of paraneoplastic syndrome in cancers?

Answer 1

8%

Question 2

What is paraneoplastic cerebellar degernation?

Answer 2

Poor balance, visual disturbance, slurred speech, nystagmus, poor co-ordination.

Often presents before the cancer

No atrophic changes to celebellar on MRI

Question 3

Cause of paraneoplastic cerebellar degernation?

Answer 3

Anti-bodies produced by cancers

1) Anti-Yo - Breast, ovarian, endometrial

Question 4

What is paraneoplastic encephalitis? Causes?

Answer 4

Neuropsychiatric syndromes - central or peripheral. Seizures, behavioural change

Antibodies against intracellular neural protein or neural surface protein.

Question 5

Example of antibody direct against intracellular neural protein. Why cancers produce this?

Answer 5

anti-Hu
Small cell lung cancer
Gynae Ovarian carcinoma

Question 6

Example of antibody directed against neural surface protein. Why cancel produce this?

Answer 6

NMDAR antibody
Mature ovarian teratoma

Presents headache/fever
Mortality 15%

Question 7

Which hormones are produce from tumours to causes paraneoplastic Cushing’s syndrome?

Which cancers?

Answer 7

ACTG, rarely ACH

50-60% small cell lung cancer
Gynae:
Endometrial adenocarcinoma
Ovarian teratoma

Question 8

How common is pregnancy associated hypercalaemia in oncology patients?

Causes?

Answer 8

30%

Bont metastatic disease
Parathyroid hormone related protein

Question 9

Which gynaecological cancers produced PTHrP?

Answer 9

Clear cell carcinomas
Small cell ovarian carcinoma - highly aggressive Dx in young women (SMARCA4)

Question 10

Symptoms of hypercalaemia?

Answer 10

Pain
Renal failure
Constupation
Abdo discomfort
CNS disturbance
Behavioural changes
Dehydrated

Question 11

Which gynaecological tumours can cause paraneoplastic hyperthyroidism?

Answer 11

1. Struma ovarii (ovarian teratoma) - >50% of tissue is thyroid tissues. 2.7% of all dermoid. Antithyroid meds and surgery
2. GTD - higher hCG which has similar structure to TSH

Question 12

What is dermatomyositis and which gynaecological cancers is it typically seen?

Answer 12

Autoimmune inflammaotry myopathy associated with cutaneous changes.
25% paraneoplastic

Ovarian cancer

Question 13

Table summarising the paraneoplastic syndromes

Answer 13