Paraneoplastic syndromes


  • Syndrome associated with cancer, but not due to direct, local effects of neoplasm
  • Result of hormones/substances secreted by malignant cells or immune response to cancer cells/products


Syndrome Main causal cancers Mechanism
Cushing syndromeSmall cell lung cancer, pancreatic carcinoma, neural tumors, thymomaEctopic ACTH/ACTH-like substance production
SIADHSmall cell lung cancer, CNS malignanciesEctopic ADH production
HypercalcemiaLung (esp. SCC), breast, renal/bladder, ovarian, multiple myeloma, adult T cell leukemia/lymphoma, squamous cell carcinoma
HypoglycemiaSarcomas, insulinoma, hepatocellular carcinomaInsulin/IGF production
Carcinoid syndromeBronchial adenoma, pancreatic and gastric carcinomaSerotonin or bradykinin production
HyperaldosteronismAdrenal adenoma, non-Hodgkin's lymphoma, ovarian carcinoma, lung cancerincreased/ectopic aldosterone production
Lambert-Eaton myasthenic syndromeSmall cell lung cancerImmune-mediated
Paraneoplastic cerebellar degenerationLung, ovarian, breast cancers, Hodgkin's lymphoma
Opsoclonus myoclonus syndromeNeuroblastoma (occurs in 2-3% of peds cases), breast, ovarian, small-cell carcinomaAutoimmune; s/sx include opsoclonus/myoclonus and other cerebellar dysfunction, aphasia, lethargy/irritability
Brain-stem or limbic encephalitisSmall cell lung cancer, germ-cell testicular tumorsAutoantibodies against intracellular neuronal proteins
Anti-NMDA receptor encephalitisGyn tumors (esp. teratomas)Anti-NMDA receptor auto-antibodies
Polymyositis/DermatomyositisLymphoma, lung, pancreatic, stomach, bladder, ovarianautoimmune
Acanthosis nigricansGastric, lung, uterineEpidermal growth factor secretion
Misc. derm conditions (Sweet's syndrome, Leser-Trelat sign, pyoderma gangrenosum, florid cutaneous papillomatosis, necrolytic migratory erythema, hypertrichosis)lung, GI adenocarcinomas, breast and GU cancers, lymphoma
VTE, thrombophlebitisany advanced cancer. Pancreatic and bronchogenic carcinomas associated w/trousseau's signHypercoagulability
PolycythemiaRenal cell carcinoma, cerebellar hemangioma, hepatocellular carcinomaIncreased erythropoietin production
Membranous glomerulonephritistumor antigens/immune complexes
Thymoma-associated multiorgan autoimmunityThymomasimilar to GVHD


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