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Some general reactions to cancer may constitute its revealing symptom, or occur during its evolution.
These paraneoplastic syndromes are systemic symptoms which appear (and disappear) with the tumour. Most of these syndromes are very rare although their list might seem long.
These syndromes are among the best known and explored: they are the consequence of an ectopic secretion of a substance which mimics a hormone (or is the hormone itself). Its very elevated blood concentration explains the disappearance of the syndrome when the tumour is removed.
Some are very classical:
- the ectopic secretion of β -HCG by placental choriocarcinoma and germinal tumours, of gonadal or extra-gonadal origin. This secretion may provoke mono- or bilateral breast gynecomastia,
- the ectopic secretion of PTH (para-thyroid hormone) during malignant hypercalcaemia of squamous head and neck cancer, or lung or oesophagus tumours,
- the ectopic secretion of ACTH (Cushing’s syndrome) accompanying small cell lung cancers,
- the ectopic secretion of ADH (Schwartz-Bartter's syndrome with hyponatremia and edema) accompanying small cell lung cancers,
- the ectopic secretion of GH (Growth Hormone: hypertrophic pulmonary osteoarthropathy or Bamberger-Marie's disease: mild arthralgia with typical digital clubbing) as seen in bronchogenic carcinoma,
They are very frequent and of various types:
- Erythrocytosis of renal tumours of various types and cerebellum hemangioblastomas which are often explained by erythropoietin ectopic secretion,
- Anaemias of various aetiologies
- blood loss by hemorrhage of the cancer itself,
- inflammatory syndrome,
- intra-vascular disseminated coagulation,
- auto-immune diseases during B lymphoid tumours,
- poor absorption of B12 vitamin and folic acid.
Most anaemia during the terminal phase has no precise aetiology and is considered to be part of terminal cachexia.
- Leukocyte alterations :
- Pseudo-leukaemic reaction which might be a symptom of medullar invasion,
- Deregulation of secretion of growth factor GM-CSF, without medullar invasion.
a well-known factor of any inflammatory syndrome in cancer,
occurring during intra-vascular disseminated coagulation,
auto-immune purpura haemorrhagica during lympho-proliferative syndromes.
- Various coagulation disorders.
Cancers can produce skin metastases (breast cancer, permeation nodules, tumour fistula) which should be diagnosed. Other dermatological syndromes include:
- Dermatomyositis or polymyositis,
which can occur in various kinds of cancer, with its typical lilac-coloured (heliotrope) erythema over the bridge of the nose, the orbital regions, cheeks, forehead, with lilac-coloured lines on the hand and around the nails. The muscular syndrome is more or less severe, and more important on proximal muscles. Treatment involves the treatment of the tumour and is completed by corticosteroids.
- Other paraneoplastic syndromes :
- Breast Paget's disease : eczema of the nipple,
- acquired ichtyosis during Hodgkin’s disease,
- acanthosis nigricans (hyperpigmentation seen on axilla et hyperkeratosis of skin folds) during digestive cancers,
- erythema gyratum repens,
- hypertrichosis lanuginosa acquisita (face hair during pulmonary and digestive cancers).
Most neurological manifestations are in relation with a direct lesion by a metastasis.
Some are claimed to be paraneoplastic: