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Questions and Answers
Which of the following syndromes is primarily associated with ectopic production of erythropoietin by cancer cells?
Which of the following syndromes is primarily associated with ectopic production of erythropoietin by cancer cells?
What is the typical hematocrit level in men diagnosed with paraneoplastic erythrocytosis?
What is the typical hematocrit level in men diagnosed with paraneoplastic erythrocytosis?
Which type of cancer is NOT typically associated with granulocytosis?
Which type of cancer is NOT typically associated with granulocytosis?
What is the primary cytokine involved in the development of eosinophilia in paraneoplastic syndromes?
What is the primary cytokine involved in the development of eosinophilia in paraneoplastic syndromes?
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What type of cancers is primarily associated with thrombocytosis?
What type of cancers is primarily associated with thrombocytosis?
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Which of the following is a common symptom of paraneoplastic erythrocytosis?
Which of the following is a common symptom of paraneoplastic erythrocytosis?
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Which of the following cytokines plays a role in both granulocytosis and thrombocytosis?
Which of the following cytokines plays a role in both granulocytosis and thrombocytosis?
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What is the relationship between the severity of paraneoplastic syndromes and cancer progression?
What is the relationship between the severity of paraneoplastic syndromes and cancer progression?
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What should be measured in patients with erythrocytosis due to renal cell cancer, hepatoma, or CNS cancer?
What should be measured in patients with erythrocytosis due to renal cell cancer, hepatoma, or CNS cancer?
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What is indicated if the red cell mass in a patient is elevated?
What is indicated if the red cell mass in a patient is elevated?
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Which treatment is likely to resolve erythrocytosis in patients with cancer?
Which treatment is likely to resolve erythrocytosis in patients with cancer?
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In cancer patients, granulocytosis is typically observed in which stage of the disease?
In cancer patients, granulocytosis is typically observed in which stage of the disease?
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What prognosis is associated with thrombocytosis in cancer patients?
What prognosis is associated with thrombocytosis in cancer patients?
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Which condition is the most common thrombotic event in patients with cancer?
Which condition is the most common thrombotic event in patients with cancer?
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What may be an initial manifestation of cancer, according to migratory or recurrent cases?
What may be an initial manifestation of cancer, according to migratory or recurrent cases?
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Which symptom would typically present in cancer patients developing deep venous thrombosis?
Which symptom would typically present in cancer patients developing deep venous thrombosis?
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Which condition is characterized by dark discoloration in body folds and creases?
Which condition is characterized by dark discoloration in body folds and creases?
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Which symptom is NOT associated with Dermatomyositis?
Which symptom is NOT associated with Dermatomyositis?
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What is a common inflammatory effect of Leukocytoclastic Vasculitis?
What is a common inflammatory effect of Leukocytoclastic Vasculitis?
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Which condition presents with painful, edematous, and erythematous lesions on the skin?
Which condition presents with painful, edematous, and erythematous lesions on the skin?
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Which of the following is a characteristic symptom of Hypertrophic Osteoarthropathy?
Which of the following is a characteristic symptom of Hypertrophic Osteoarthropathy?
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Which paraneoplastic syndrome is known as a fatal blistering disease?
Which paraneoplastic syndrome is known as a fatal blistering disease?
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Which treatment approach is recommended for managing dermatologic and rheumatologic paraneoplastic syndromes?
Which treatment approach is recommended for managing dermatologic and rheumatologic paraneoplastic syndromes?
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Which symptom is typically associated with Sweet Syndrome?
Which symptom is typically associated with Sweet Syndrome?
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Which of the following symptoms are commonly observed in patients with pulmonary embolism?
Which of the following symptoms are commonly observed in patients with pulmonary embolism?
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What is the typical treatment regimen for a patient diagnosed with pulmonary embolism?
What is the typical treatment regimen for a patient diagnosed with pulmonary embolism?
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Which of the following cancers is most commonly associated with hypercalcemia?
Which of the following cancers is most commonly associated with hypercalcemia?
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What is a likely mechanism behind neurological paraneoplastic syndromes?
What is a likely mechanism behind neurological paraneoplastic syndromes?
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Which of the following is not commonly associated with neurological paraneoplastic syndromes?
Which of the following is not commonly associated with neurological paraneoplastic syndromes?
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What are the treatments for neurological paraneoplastic syndromes?
What are the treatments for neurological paraneoplastic syndromes?
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Paraneoplastic encephalomyelitis may include which additional condition?
Paraneoplastic encephalomyelitis may include which additional condition?
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Which neurological condition is not typically a result of paraneoplastic syndromes?
Which neurological condition is not typically a result of paraneoplastic syndromes?
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Which of the following features indicates a severe presentation of pulmonary embolism on physical examination?
Which of the following features indicates a severe presentation of pulmonary embolism on physical examination?
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In which situation could paraneoplastic syndrome manifest before cancer diagnosis?
In which situation could paraneoplastic syndrome manifest before cancer diagnosis?
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What defines a paraneoplastic syndrome?
What defines a paraneoplastic syndrome?
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Which pathway is NOT a mechanism through which paraneoplastic syndromes occur?
Which pathway is NOT a mechanism through which paraneoplastic syndromes occur?
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Cushing Syndrome as a paraneoplastic syndrome primarily results from the production of which hormone?
Cushing Syndrome as a paraneoplastic syndrome primarily results from the production of which hormone?
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Which of the following symptoms is commonly associated with Hypercalcemia of malignancy?
Which of the following symptoms is commonly associated with Hypercalcemia of malignancy?
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What type of cancer is most commonly associated with the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)?
What type of cancer is most commonly associated with the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)?
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Which treatment is NOT typically used for managing Hypercalcemia of malignancy?
Which treatment is NOT typically used for managing Hypercalcemia of malignancy?
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What characterizes endocrinal paraneoplastic syndromes?
What characterizes endocrinal paraneoplastic syndromes?
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Which of the following is NOT a typical tumor type associated with Cushing Syndrome?
Which of the following is NOT a typical tumor type associated with Cushing Syndrome?
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What is a common presentation symptom of SIADH?
What is a common presentation symptom of SIADH?
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Which syndrome is characterized by muscle weakness, hypertension, and weight gain?
Which syndrome is characterized by muscle weakness, hypertension, and weight gain?
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Which symptom is most commonly associated with hypercalcemia?
Which symptom is most commonly associated with hypercalcemia?
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What role does vasopressin play in paraneoplastic syndromes?
What role does vasopressin play in paraneoplastic syndromes?
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Which of these is NOT classified as a type of paraneoplastic syndrome?
Which of these is NOT classified as a type of paraneoplastic syndrome?
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Which protein is primarily responsible for stimulating erythrocytosis in paraneoplastic syndromes?
Which protein is primarily responsible for stimulating erythrocytosis in paraneoplastic syndromes?
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Which of the following is a characteristic hematocrit level in men presenting with paraneoplastic erythrocytosis?
Which of the following is a characteristic hematocrit level in men presenting with paraneoplastic erythrocytosis?
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Which cancer type is typically associated with eosinophilia in paraneoplastic syndromes?
Which cancer type is typically associated with eosinophilia in paraneoplastic syndromes?
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What is the typical clinical presentation of erythrocytosis in paraneoplastic syndromes?
What is the typical clinical presentation of erythrocytosis in paraneoplastic syndromes?
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Which condition is NOT commonly associated with thrombocytosis in cancer patients?
Which condition is NOT commonly associated with thrombocytosis in cancer patients?
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What type of cancer is associated with ectopic production of Granulocyte Colony-Stimulating Factor (G-CSF)?
What type of cancer is associated with ectopic production of Granulocyte Colony-Stimulating Factor (G-CSF)?
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In the context of paraneoplastic syndromes, which symptom is commonly linked to thrombophlebitis?
In the context of paraneoplastic syndromes, which symptom is commonly linked to thrombophlebitis?
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Which interleukin is associated with both granulocytosis and thrombocytosis in paraneoplastic syndromes?
Which interleukin is associated with both granulocytosis and thrombocytosis in paraneoplastic syndromes?
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Which of the following accurately describes the association between granulocytosis and cancer stages?
Which of the following accurately describes the association between granulocytosis and cancer stages?
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What indirect treatment for erythrocytosis might be considered when tumors cannot be resected?
What indirect treatment for erythrocytosis might be considered when tumors cannot be resected?
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Which of the following statements regarding thrombocytosis in cancer patients is true?
Which of the following statements regarding thrombocytosis in cancer patients is true?
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What is the significance of elevated serum erythropoietin levels in a cancer patient with erythrocytosis?
What is the significance of elevated serum erythropoietin levels in a cancer patient with erythrocytosis?
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What defines Trousseau's syndrome in patients diagnosed with cancer?
What defines Trousseau's syndrome in patients diagnosed with cancer?
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Which symptom is generally associated with deep venous thrombosis in cancer patients?
Which symptom is generally associated with deep venous thrombosis in cancer patients?
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What is a critical factor in diagnosing paraneoplastic erythrocytosis in a patient with cancer?
What is a critical factor in diagnosing paraneoplastic erythrocytosis in a patient with cancer?
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Which of the following conditions is most commonly associated with thrombosis in cancer patients?
Which of the following conditions is most commonly associated with thrombosis in cancer patients?
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Which condition is primarily characterized by painful, edematous, and erythematous lesions on the skin?
Which condition is primarily characterized by painful, edematous, and erythematous lesions on the skin?
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What symptom is NOT characteristic of Dermatomyositis?
What symptom is NOT characteristic of Dermatomyositis?
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Which paraneoplastic syndrome is known for causing a fatal blistering disease?
Which paraneoplastic syndrome is known for causing a fatal blistering disease?
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Which of these symptoms is primarily linked to Hypertrophic Osteoarthropathy?
Which of these symptoms is primarily linked to Hypertrophic Osteoarthropathy?
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What is the primary management strategy for dermatologic and rheumatologic paraneoplastic syndromes?
What is the primary management strategy for dermatologic and rheumatologic paraneoplastic syndromes?
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Which symptom is NOT commonly associated with Sweet Syndrome?
Which symptom is NOT commonly associated with Sweet Syndrome?
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Which of the following accurately describes Acanthosis Nigricans?
Which of the following accurately describes Acanthosis Nigricans?
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What condition is indicated by inflammation in small blood vessels leading to tissue destruction?
What condition is indicated by inflammation in small blood vessels leading to tissue destruction?
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What is the typical initial treatment for patients diagnosed with pulmonary embolism?
What is the typical initial treatment for patients diagnosed with pulmonary embolism?
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Which of the following statements about paraneoplastic neurological syndromes is accurate?
Which of the following statements about paraneoplastic neurological syndromes is accurate?
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Which symptom is least likely to be seen during a physical examination of a patient with pulmonary embolism?
Which symptom is least likely to be seen during a physical examination of a patient with pulmonary embolism?
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Paraneoplastic syndromes related to neurological symptoms typically involve which mechanism?
Paraneoplastic syndromes related to neurological symptoms typically involve which mechanism?
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What is the potential benefit of suppressing the immune response in treating paraneoplastic syndromes?
What is the potential benefit of suppressing the immune response in treating paraneoplastic syndromes?
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Which of the following neurological conditions is specifically associated with paraneoplastic syndromes?
Which of the following neurological conditions is specifically associated with paraneoplastic syndromes?
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In the context of paraneoplastic syndromes, which condition is primarily linked to a hypercalcemia diagnosis?
In the context of paraneoplastic syndromes, which condition is primarily linked to a hypercalcemia diagnosis?
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Which of the following is NOT a paraneoplastic neurological disease?
Which of the following is NOT a paraneoplastic neurological disease?
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What distinguishes paraneoplastic syndromes from direct cancer effects?
What distinguishes paraneoplastic syndromes from direct cancer effects?
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Which type of cancer is least likely to cause neurological paraneoplastic syndromes?
Which type of cancer is least likely to cause neurological paraneoplastic syndromes?
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What is the primary mechanism by which paraneoplastic syndromes are mediated?
What is the primary mechanism by which paraneoplastic syndromes are mediated?
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Which of the following conditions is a hematologic paraneoplastic syndrome?
Which of the following conditions is a hematologic paraneoplastic syndrome?
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What factor is primarily responsible for the condition known as hypercalcemia of malignancy?
What factor is primarily responsible for the condition known as hypercalcemia of malignancy?
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Which symptom is least likely to be associated with the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)?
Which symptom is least likely to be associated with the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)?
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In the context of endocrinal paraneoplastic syndromes, what effect does successful treatment of the underlying tumor often have?
In the context of endocrinal paraneoplastic syndromes, what effect does successful treatment of the underlying tumor often have?
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Which type of tumor is NOT typically associated with Cushing Syndrome?
Which type of tumor is NOT typically associated with Cushing Syndrome?
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What is a common treatment approach for managing hypercalcemia of malignancy?
What is a common treatment approach for managing hypercalcemia of malignancy?
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Which type of paraneoplastic syndrome is characterized by alterations in glucose metabolism?
Which type of paraneoplastic syndrome is characterized by alterations in glucose metabolism?
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Which condition is most commonly recognized in patients with paraneoplastic hypercalcemia?
Which condition is most commonly recognized in patients with paraneoplastic hypercalcemia?
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What hormonal change occurs in Cushing Syndrome?
What hormonal change occurs in Cushing Syndrome?
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Which of the following conditions may precipitate confusion in patients suffering from SIADH?
Which of the following conditions may precipitate confusion in patients suffering from SIADH?
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What is the typical metabolic derangement associated with hypercalcemia of malignancy?
What is the typical metabolic derangement associated with hypercalcemia of malignancy?
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Which clinical feature is most characteristic of paraneoplastic endocrine syndromes?
Which clinical feature is most characteristic of paraneoplastic endocrine syndromes?
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Which condition is a serious potential consequence of untreated hypercalcemia of malignancy?
Which condition is a serious potential consequence of untreated hypercalcemia of malignancy?
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Study Notes
Paraneoplastic Syndromes (L4)
- Paraneoplastic syndromes are disorders that accompany benign or malignant tumors.
- They are not directly related to the tumor's mass effects or invasion.
- Atypical clinical findings in a cancer patient should raise suspicion of a paraneoplastic syndrome.
Pathogenesis
- Paraneoplastic syndromes are mediated through:
- Cross-reacting antibodies
- Production of physiologically active factors
- Interference with normal metabolic pathways
- Idiopathic mechanisms
Types of Paraneoplastic Syndromes
- Endocrine paraneoplastic syndromes
- Hematologic paraneoplastic syndromes
- Neurological paraneoplastic syndromes
- Dermatological paraneoplastic syndromes
Endocrine Paraneoplastic Syndromes
- Result from hormone/peptide production causing metabolic disturbances.
- Successful tumor treatment often improves these conditions.
- Common syndromes include:
- Cushing syndrome (ectopic ACTH production)
- Hypercalcemia
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion)
- Hypoglycemia
Hypercalcemia of Malignancy
- Caused by PTHrP (Parathyroid hormone-related protein).
- Clinical presentation includes altered mental status, weakness, ataxia, lethargy, hypertonia, renal failure, hypertension (HTN), and bradycardia.
- Typical tumor types: Squamous cell (head & neck, lung, skin), breast, genitourinary, and gastrointestinal.
- Treatment: Saline hydration, forced diuresis with loop diuretics, and bisphosphonates.
SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion)
- Caused by ectopic vasopressin production.
- Clinical presentation includes gait disturbance, falls, headache, nausea, fatigue, cramps, anorexia, confusion, lethargy, seizures, and coma.
- Typical tumor types: Lung (squamous, small cell), gastrointestinal, genitourinary, and ovarian.
- Treatment: Treatment of the cause, fluid restriction, and hypertonic saline.
Hematologic Paraneoplastic Syndromes
-
Less well characterized than endocrine syndromes.
-
Severity often parallels the course of the cancer.
-
Common syndromes include erythrocytosis, granulocytosis, thrombocytosis, eosinophilia, thrombophlebitis, and thrombophlebitis.
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Erythrocytosis associated with: Renal cancers, hepatocarcinoma, cerebellar hemangioblastomas, lung cancer, gastrointestinal cancer, and ovarian cancer
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Granulocytosis associated with: Lung cancer, gastrointestinal cancer, ovarian cancer, genitourinary cancer, and Hodgkin's disease.
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Thrombocytosis associated with: Lung cancer, gastrointestinal cancer, breast cancer, ovarian cancer, lymphomas, lymphoma, leukemia.
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Thrombophlebitis associated with Lung cancer, pancreatic cancer, gastrointestinal cancer, breast cancer, genitourinary cancer, ovarian cancer, and lymphoma, prostate cancer
Neurological Paraneoplastic Syndromes
- Immune-mediated diseases targeting the nervous system are caused by onconeural antibodies and associated onconeural antigen-specific T lymphocytes.
- Common syndromes include:
- Paraneoplastic encephalomyelitis
- Limbic encephalitis
- Brainstem encephalitis
- Paraneoplastic cerebellar degeneration (PCD)
- Paraneoplastic opsoclonus-myoclonus (POM)
- Paraneoplastic retinal degeneration
- Myelitis, Motor neurone syndromes, Sensory neuropathy, Sensorimotor neuropathy, Motor neuronopathy, Myasthenia gravis, Polymyositis/dermatomyositis (PM/DM), Acute necrotising myopathy
Dermatologic & Rheumatologic Paraneoplastic Syndromes
- Many dermatologic and rheumatologic paraneoplastic syndromes occur without associated malignancy.
- Management often involves cancer-directed therapy along with standard treatments for the corresponding non-paraneoplastic conditions.
- Development often precedes or accompanies cancer diagnosis/recurrence.
- Examples:
- Acanthosis nigricans (dark skin discoloration)
- Dermatomyositis (muscle weakness/skin rash)
- Hypertrophic osteoarthropathy (digital clubbing, bone changes)
- Leukocytoclastic vasculitis (small blood vessel inflammation)
- Paraneoplastic pemphigus (mucous membrane blistering)
- Sweet syndrome (painful skin lesions)
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