Paraneoplastic Syndromes

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Definition

-  Biological effects that are distant from the site of the cancer or metastasis

-  Caused by either

-  Deregulation of production of hormones, cytokines or growth factors

-  Ab production against tumour related Ag w cross reactivity to host tissue

 

Types

-  Endocrine

-  Haematological

-  Neurological

-  Miscellaneous

 

 

 

Endocrine

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-  Hypercalcaemia

-  Ectopic ACTH

-  Other

 

Hypercalcaemia

-  Majoroty from PTH-RP (PTH related peptide), also Vit D, PGs or cytokines

-  Associated w

-  MM

-  Breast Ca

-  Non-Small Cell Lung Ca

-  Colon Ca

-  Lymphoma

-  Renal

-  Dx

-  Usually acute onset

-  Polyuria, polydipsia, ARF, drowsiness, confusion, coma, pain, nausea, constipation, vomiting

-  Mx

-  As per Hypercalcaemia

 

Ectopic ACTH

-  Associated w

-  Small Cell Lung Ca (50% of cause), Non-Small Cell Lung Ca, Thymus, Pancreas, Carcinoid

-  Dx

-  Hirsuitism, hyperpigmentation

-  HTN, proximal myopathy

-  Hypokalaemia

-  NO buffalo hump or striae

-  DDx Cushings Syndrome

-  Mx

-  Chemotherapy

-  Surgery

-  Ketoconozole

 

Others

-  Osteomalacia

-  Hypoglycaemia

-  Gynacomastia

-  Hypocalcaemia

-  Thyrotoxicosis

 

 

 

Haematological

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Erythrocytosis

-  Increase EPO

-  Associated w

-  Renal cell carcinoma, hepatoma, cerebellar hemangioblastomas

 

Other

-  Anaemia

-  Leukocytosis

 

 

 

Neurological

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Eaton Lambert Syndrome

-  Ab against presynaptic nerve terminals

-  60% have malignancy: 66% Small Cell Lung Ca

-  S/S

-  Proximal weakness, dysphagia

-  Mx

-  Plasmaphoresis

-  Immunosuppression

 

Dermatomyositis & Polymyositis

-  Ca in 10-50%

-  Lung Ca common

-  S/S

-  Proximal myopathy +/- muscle pain

-  Purple skin rash in Dermatomyositis

-  Dx

-  Mmuscle biopsy

-  Mx

-  Steroids

 

 

 

Miscellaneous

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Hypertrophic Pulmonary Osteoarthritis (HPOA)   

-  Clubbing

-  Wrist pain: periosteal bone changes

-  Causes

-  Non-Small Cell Lung Ca

-  Liver disease

-  IBD

-  Mx

-  NSAIDs

-  Steroids