Paraneoplastic syndromes

Question 1

Paraneoplastic syndrome: Definition

Answer 1

Rare disorders that are triggered by an altered immune response to a neoplasm.

Paraneoplastic syndromes consist of symptoms attributable to a malignancy mediate by hormones, cytokines or the cross-reaction of tumour antibodies.

They do not correlate with stage or prognosis and may pre-date any other cancer problems.

Question 2

Paraneoplastic syndromes: Examples (9)

Answer 2

• Hypercalcaemia
• SIADH
• Cushing’s syndrome
• Neuropathy
• Lambert-Eaton myasthenic syndrome
• Dermatomyositis + polymyositis
• Acanthosis nigricans
• Pemphigus
• Hypertrophic osteoarthropathy

Question 3

Paraneoplastic syndromes: Hypercalcaemia

• Comment
• Malignancies

Answer 3

Comment: Parathyroid hormone related protein secreted by tumour

Malignancies: Lung, oesophagus, skin, cervix, breast, kidney

Question 4

Paraneoplastic syndromes: SIADH

• Comment
• Malignancies

Answer 4

Comment: Excessive antidiuretic hormone (ADH) secretion causing decreased sodium

Malignancies: Lung, pancreas, lymphomas, prostate

Question 5

Paraneoplastic syndromes: Cushing’s syndrome

• Comment
• Malignancies

Answer 5

Comment: Tumour secretes ACTH or CRF, causing adrenal to produce high levels of corticosteroid

Malignancies: Lung, pancreas, thymus, carcinoid

Question 6

Paraneoplastic syndromes: Neuropathy

• Comment
• Malignancies

Answer 6

Comment: Antibody mediated neuronal degeneration: peripheral, autonomic, cerebellar.

Malignancies: Lung, breast, myeloma, Hodgkin’s, GI

Question 7

Paraneoplastic syndromes: Lambert Eaton syndrome

• Comment
• Malignancies

Answer 7

Comment: Antibody to voltage gated ion channel on pre-synaptic membrane causes weakness (proximal leg most common)

Malignancies: Mostly lung, also GI, breast, thymus

Question 8

Paraneoplastic syndromes: Dermatomyositis + polymyositis

• Comment
• Malignancies

Answer 8

Comment: Inflammation of the muscles +/- heliotrope rash

Malignancies: Lung, breast, ovary, GI

Question 9

Paraneoplastic syndromes: Acanthosis nigricans

• Comment
• Malignancies

Answer 9

Comment: Velvety, hyperpigmented skin (usually flexural)

Malignancies: GI

Question 10

Paraneoplastic syndromes: Hypertrophic osteoarthropathy

• Comment
• Malignancies

Answer 10

Comment: Periosteal bone formation, arthritis and finger clubbing

Malignancies: Lung