PARANEOPLASTIC SYNDROME
- Forms the major part in clinical aspects of neoplasms.
- Defined as “Syndrome complexes” that cannot be explained by tumor spread or release of indigenous hormones by those tumors.
| Clinical syndromes | Major underlying cancers | Causal mechanism |
| Cushing syndrome |
Lung cancer (small cell, bronchial, carcinoid (Most common), adenocarcinoma, squamous cell carcinoma)
Thymoma Medullary thyroid cancer Pancreatic carcinoma Neural tumors |
Ectopic ACTH/ACTH-like substances. |
|
Pancreatic cancer, lung cancer,
prostate cancer, Carcinoid |
Corticotropin-releasing hormone
(CRH) |
|
| SIADH | Small cell carcinoma of lung (Squamous cell ca.) | ADH or atrial natriuretic hormone |
| Hypercalcemia (most common paraneoplastic syndrome) |
Squamous cell cancer of head & neck, lung, skin.
Small cell carcinoma Breast carcinoma (Most common) Gastrointestinal Genitourinary tumours |
Parathyroid hormone-related peptide (PTHRP) TGF-a, TNF, IL-1
1,25 dihydroxy vitamin D Prostaglandin E2 Parathormone (Rare)
|
| Hypoglycemia |
Ovarian carcinosarcomas
Mesenchymal sarcomas Fibrosarcoma Insulinoma Hepatocellular carcinoma |
Insulin or insulin-like substance (IGF-II) |
| Polycythemia |
Renal carcinoma
Cerebellar hemangioma Hepatocellular carcinoma |
Erythropoietin |
| Myasthenia gravis |
Bronchogenic carcinoma
Thymoma |
Immunologic
Antibodies against post-synaptic Ach receptors at NMJ. |
|
Acanthosis nigricans
Hyperpigmented velvety plaques in axilla & neck. |
Gastric adenocarcinoma
Lung carcinoma Uterine carcinoma |
Immunologic, Epidermal growth factor |
| Dermatomyositis & polymyositis |
Bronchogenic carcinoma
Breast carcinoma Colorectal carcinoma |
Immunologic |
|
Hypertrophic
osteoarthropathy and clubbing of fingers |
Bronchogenic carcinoma
Thymic neoplasms |
Unknown |
|
Migratory thrombophlebitis
(Trousseau phenomenon) |
Adenocarcinoma mainly,
Pancreatic carcinoma Bronchogenic carcinoma |
Tumor products (mucins that activate clotting) |
| DIC |
Acute promyelocytic leukemia
Prostatic carcinoma |
Tumor products that activate clotting |
| Oncogenic osteomalacia | Hemangiopericytomas, osteoblastoma, fibromas, sarcomas, giant cell tumors | Phosphatonin (fibroblast growth factor 23-FGF23) |
Paraneoplastic syndromes associated with Hepatocellular Carcinoma (HCC):
- Hypoglycemia
- Erythrocytosis
- Hypercalcemia
- Hypercholesterolemia
- Dysfibrinogenemia
- Carcinoid syndrome
- Increased thyroxin-binding globulin
- Changes in secondary sex characteristics (gynecomastia, testicular atrophy, and precocious puberty)
Exam Important
- Paraneoplastic Syndrome seen in RCC is Acanthosis nigricans, Hypertension, Hypercalcemia, Amyloidosis and Polycythemia.
- Two important causes of paraneoplastic syndrome among the cancers are Small cell carcinoma lung and carcinoid
- Cushing syndrome as paraneoplastic syndrome is seen with Bronchial carcinoid, Thymus, Medullary carcinoma thyroid
- Paraneoplastic syndrome is associated with Renal Ca & Breast Ca
- Parathyroid-related peptide causes lung carcinoma & increased PTH
- ACTH, ADH and Carcinoid syndrome are the paraneoplastic syndromes seen with small cell ca lung.
- The paraneoplastic syndrome associated with Hodgkin’s disease is Cerebellar degenerative disease.
Click Here to Start Quiz
