Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 39-02: The Paraneoplastic Syndromes + Key Features Download Section PDF Listen +++ ++ Small cell lung cancer is most common tumor association Can occur despite relatively limited neoplastic growth May provide an early clue to presence of certain types of cancer Course usually parallels course of the cancer Effective cancer treatment should be accompanied by resolution of the syndrome Conversely, recurrence of the cancer is sometimes heralded by return of syndrome Metabolic or toxic effects of the syndrome (eg, hypercalcemia, hyponatremia) may be a more urgent hazard to life than the underlying cancer Many of the neuromuscular, dermatologic and rheumatologic paraneoplastic syndromes are caused by antibodies directed against tumor antigens that share epitopes with normal tissue; testing for antibodies can often detect syndrome-specific antibodies + Clinical Findings Download Section PDF Listen +++ ++ Hypercalcemia, hyponatremia Clinical manifestations of cancer are usually due to Pressure effects of local tumor growth Infiltration or metastatic deposition of tumor cells in a variety of organs in the body Certain systemic symptoms Patients with advanced or widespread metastatic cancer may have anorexia, malaise, weight loss, and sometimes fever Systemic symptoms of cancer are usually not specific (except in the case of functioning tumors) In the paraneoplastic syndromes, clinical findings may resemble those of primary endocrine, dermatologic, rheumatologic, hematologic, or neuromuscular disorders + Diagnosis Download Section PDF Listen +++ ++ See eTable 39–1 ++Table Graphic Jump LocationeTable 39–1.Paraneoplastic syndromes associated with cancer.View Table||Download (.pdf)eTable 39–1. Paraneoplastic syndromes associated with cancer. Hormone Excess or Syndrome Non–Small Cell Lung Cancer Small Cell Lung Cancer Breast Cancer Renal Cell Carcinoma Adrenal Cancer Hepatocellular Carcinoma Gastrointestinal Cancers Plasma Cell Myeloma Lymphoma Thymoma Prostatic Cancer Ovarian Cancer Choriocarcinoma Germ Cell Cancers Endocrine Hypercalcemia ++ ++ ++ ++ ++ + ++ Cushing syndrome + ++ + ++ ++ + SIADH ++ ++ Hypoglycemia + ++ + Gonadotropin secretion + ++ + + + + ++ ++ Hyperthyroidism Hematologic Erythrocytosis ++ + ++ Pure red cell aplasia + ++ Coagulopathy ++ ++ ++ + Thrombophlebitis + ++ ++ + Neurologic Lambert-Eaton myasthenic syndromes + ++ + + + + + Subacute cerebellar syndrome ++ + + + + Sensory motor peripheral neuropathy ++ Stiff man syndrome + Dermatologic Dermatomyositis ++ ++ + + + Acanthosis nigricans + + ++ + Fever ++ ++ ++ + Hypertrophic osteoarthropathy ++ +, reported associated; ++, strong association.SIADH, syndrome of inappropriate antidiuretic hormone. + Treatment Download Section PDF Listen +++ ++ Treatment of underlying malignancy Bisphosphonates, corticosteroids (depending on tumor type) for hypercalcemia Symptomatic measures