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 llymphoma
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
Limbic or brain-stem 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 igricans Gastric, lung, uterine Epidermal growth factor secretion
Misc. derm conditions (Sweet's syndrome, Leser-Trelat sign, pyoderma gangrenosum, florid cutaneous papilomatosis, necrolytic migratory erythema, hypertrichosis) lung, GI adenocarcinomas, breast and GU cancers, lymphoma
VTE, thrombophlebitis any advanced cancer. Pancreatic and bronchogenic carcinomas associated w/troussau's sign Hypercoaguability
Polycythemia Renal cell carcioma, cerebellar hemangioma, hepatocellular carcinoma Increased erythropoiten production
Granulocytosis various C-GSF
Membranous glomerulonephritis tumor antigens/immune complexes
Thymoma-associated multiorgan autoimmunity Thymoma similar to GVHD

References

Authors:

Claire