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Paraneoplastic Syndromes
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Paraneoplastic syndromes are those diseases directly associated with having a certain type of cancer. There are numerous paraneoplastic syndromes possible and it depends on the type of cancer and the various humoral factors (hormones or cytokines) excreted by the cancerous cells. A paraneoplastic syndrome can also be caused by the immune response of the body to the tumor. The most common paraneoplastic syndromes are caused by cancers of the breast, ovaries, lung or lymphatic system. The paraneoplastic syndrome can be the harbinger of the presence of the tumor without other symptoms present.
There are for main categories of paraneoplastic syndromes, including neurological paraneoplastic syndromes, endocrine paraneoplastic syndromes, mucocutaneous syndromes and hematological syndromes.
Endocrine paraneoplastic syndromes include the presence of Cushing's disease. It results in a production of ACTH by the tumor. The most common cancers that cause Cushing's disease include small cell lung cancer, neural tumors, tumors of the thymus and pancreatic cancer. Another syndrome is called SIADH or syndrome of inappropriate ADH secretion. It results from small cell lung cancer and cancers of the nervous system. Hypercalcemia is a result of parathyroid hormone-related protein, secreted by lung cancers, breast cancer and kidney cancer. Multiple myeloma and adult T cell cancer can also cause hypercalcemia. Hypoglycemia results from a syndrome which involves increased insulin secretion from fibrosarcoma, hepatic cancers or mesenchymal sarcomas. Carcinoid syndrome results from excess bradykinin or serotonin release and comes from bronchial, gastric or pancreatic cancers.
Neurologic paraneoplastic syndromes provide neurological symptoms as a result of a cancer elsewhere in the body. There is a syndrome called Lambert-Eaton myasthenic syndrome which comes from small cell cancer of the lung. The mechanism of action of this syndrome is immunologic. One can get degeneration of the cerebellum as a result of having breast cancer, lung cancer or ovarian cancer. Various forms of encephalitis can result from cancers outside the neurological system.
Mucocutaneous paraneoplastic syndromes include dermatomyositis, a condition that can be primary or can result from having undisclosed breast or bronchogenic carcinoma. The mechanism of action appears to be immunologic. There are numerous other paraneoplastic syndromes associated with having cancers of various types.
Hemotological paraneoplastic syndromes are related to the blood. These can include an excess of white blood cells in granulocytosis or polycythemia-excessive amounts of red blood cells seen in renal cancer, hepatic cancer and cerebellar hemangioma. Anemia is seen in thymus cancers.
Of the above paraneoplastic syndromes, neurological paraneoplastic syndromes are considered among the most devastating. Common in those with lung cancer, breast cancer or ovarian cancer, these syndromes are believed to be related to the body's ability to fight off the cancer via the immune system. Such syndromes are uncommon and occur in about one percent or less of those who have cancer. The symptoms of these and any type of paraneoplastic syndrome can and often precede the finding of cancer itself. Symptoms can include difficulty balancing or walking, trouble swallowing, muscle weakness, loss of coordination, speech or memory difficulties and problems with seizures, sleep or dizziness.
If a paraneoplastic syndrome is suspected, the doctor can test the blood for antibodies associated with paraneoplastic syndromes or for the hormones secreted by the tumors themselves. A spinal tap may show the presence of paraneoplastic antibodies in neurological cases. CT, MRI or PET scanning can be done in order to find the source of the paraneoplastic syndrome-which will be some form of cancer. Some of the tumors, unfortunately, may be too small to see on scans and the diagnosis is unknown until the cancer is large enough to see on a new scan.
Treatment of paraneoplastic syndromes related to the immune system includes treatment with corticosteroids to block the immune system. Other medications, including Cytoxan, Cyclosporine or Prograf, are immune system blockers that can control the body's response to the tumor. Speech and physical therapy can help the sufferer do better with more strength and speech abilities. Plasmapheresis is done to remove antibodies from the body and can control the symptoms of the paraneoplastic syndrome.