Updated: 9/16/2021

Paraneoplastic Effects of Tumors

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Snapshot
  • A 62-year-old woman presents to her primary care physician with complaint of malaise and weakness for the past two months. She describes that she has difficulty getting out of a chair as well as climbing the few steps up to her front door. The patient has a 36-pack-year smoking history. Physical examination is notable for weakness in the proximal upper and lower extremities bilaterally. Laboratory studies reveal autoantibodies against voltage-gated calcium channels. A chest radiograph is obtained and shown in the image.
Introduction
  • Overview
    • paraneoplastic syndromes occur separately from the tumor itself, but result from substances produced by the tumor
      • symptoms may affect various body systems (i.e., endocrine, hematologic, and neuromuscular)
 
Paraneoplastic Syndromes
Endocrine
Syndrome or Clinical Manifestation
Associated Tumors
Potential Tumor Products
Hypercalcemia
  • Squamous cell carcinomas of the lung, head, and heck
  • Renal carcinomas
  • Bladder carcinomas
  • Breast carcinomas
  • Ovarian carcinomas
  • PTHrP
  • ↑ 1,25-(OH)2 vitamin D3 (calcitriol)
Cushing syndrome
  • Small cell lung cancer
  • ↑ ACTH
Hyponatremia (SIADH)
  • Small cell lung cancer
  • ↑ ADH
Hematologic
Syndrome or Clinical Manifestation Associated Tumors Potential Tumor Products
Polycythemia
  • Renal cell carcinoma
  • Pheochromocytoma
  • Hemangioblastoma
  • Leiomyoma
  • Hepatocellular carcinoma
  • ↑ EPO
Neuromuscular
Lambert-Eaton myasthenic syndrome
  • Small cell lung cancer
  • Antibodies against presynaptic Ca2+ channels at the neuromuscular junction
Paraneoplastic encephalomyelitis
  • Small cell lung cancer
  • Antibodies against Hu antigens in neurons
Myasthenia gravis
  • Thymoma
  • Antibodies against postsynaptic ACh receptors at the neuromuscular junction

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