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For further information, see CMDT Part 39-02: The Paraneoplastic Syndromes

Key Features

  • 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

  • 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

eTable 39–1.Paraneoplastic syndromes associated with cancer.

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