Paraneoplastic Syndrome - Medical Malpractice Lawyers

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Paraneoplastic Syndrome - Medical Malpractice

Paraneoplastic syndromes are relatively rare disorders that seem to be triggered by an abnormal immune response to a certain cancer. There are some cancers that are more likely to trigger a paraneoplastic syndrome than others. The first report of a paraneoplastic syndrome occurred in 1890, when a French physician described a case of peripheral nervous system involvement in a patient with cancer. The cancer does not have to be severe or metastatic in order to cause a paraneoplastic syndrome. It is apparent that something is released from the tumour cells themselves that lead to the paraneoplastic syndromes. The symptoms can be related to the heart, the muscles, the skin, the nervous system, the endocrine system, the haematological system, kidneys or GI system.

Fever is the most common symptom in paraneoplastic syndrome. Other conditions you can see are polymyositis, dermatomyositis, Cushing's syndrome, neurological symptoms and malignant carcinoid syndrome. The frequency of paraneoplastic syndromes range from 2 percent to about 20 percent of malignancies. Neurologic paraneoplastic syndromes occur in less than one percent of cancer patients. They can occur in any race, gender and at any age. The incidence of deaths related to paraneoplastic syndromes is completely unknown.

In most cases, the paraneoplastic syndrome shows up before the cancer is identified. When a paraneoplastic syndrome shows up, the person should be analysed to make sure they don't have a related cancer associated with the paraneoplastic syndrome.

No one knows exactly what causes paraneoplastic syndrome. It may be related to antibodies given off when the cancer is produced. Antibodies against the cancer may cross-react and attach to normal cells, leaving them vulnerable to attack. Paraneoplastic syndrome can occur in those who don't have known cancer, those who are being treated already with cancer and those who are in remission from cancer. Doctors need a complete history and physical examination in order to identify those people who are at risk for paraneoplastic syndrome or who have symptoms thereof.

The clinical presentation of paraneoplastic syndromes can be quite varied, depending on what body system is involved. There can be fever, anorexia and cachexia (a starved appearance) in any type of paraneoplastic syndrome. Fever is most associated with things like lymphoma, leukemias, kidney tumours and GI tumours. Arthritis as a paraneoplastic syndrome occurs in patients with myelomas, lymphomas, leukemias and colon or prostate cancer. CNS tumours can lead to arthritic symptoms as well. There can be osteoarthropathy in patients who have lung cancers or some nerve tumours.

Patients with a new diagnosis of scleroderma can have findings of tumours in several places. The cancers occur most often in the breast, uterus and lung. Lupus also is a paraneoplastic syndrome with tumours found in the lung, breast, gonads or with lymphoma. Secondary amyloidosis is a connective tissue disease that occurs in patients who have renal cancer, lymphomas or myeloma.

You can also get kidney disease with various tumours. The blood potassium can be low due to potassium leakage by bad kidneys. This often happens with tumours that secrete ACTH. There are other kidney diseases that can occur with Hodgkin's lymphoma, non-Hodgkin's lymphoma, lung cancer, thyroid cancer, colon cancer, melanomas, ovarian cancer, breast cancer or pancreatic cancer.

You can get watery diarrhoea as a manifestation of a paraneoplastic syndrome. This can lead to an electrolyte imbalance and resultant confusion, weakness and fatigue. The tumours produce prostaglandins that lead to diarrhoea and malnutrition.

There are often conditions such as too many red blood cells (erythrocytosis), anaemia, excess platelets and disseminated intravascular coagulation seen with various types of cancers. These are especially difficult to determine as being paraneoplastic syndromes because they effect the blood and seem unrelated to cancers.

The treatment varies with the type and location of the specific paraneoplastic syndrome involved. The treatment of the underlying cancerous disorder is what's really necessary to get rid of the paraneoplastic syndrome.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here