Paraneoplastic syndromes

• Neoplasia is synonymous with tumor, is synonymous with anything that ends in "oma"
• Neoplasia


  An abnormal mass of tissue not normal, whose growth exceeds and is uncoordinated with that of normal tissue, and even if you remove the stimulus that caused the growth, the neoplasia is going to persist and it's not going away
• Tumors/Neoplasias/Anything that ends in "oma"


  • Can be benign or malignant
  • Malignant tumors are also known as cancers
• Carcinoma


  Cancer of the epithelium
• Sarcoma


  Cancer of connective tissue
• Carcinomas prefer to metastasize to lymph, while sarcomas prefer to metastasize to blood (at least in the beginning)
• Cancer is not a random event, as cancers do have preferences in where they metastasize
• Cancer serves no useful function, and can arise from any type of cell in the body
• Some cancers secrete substances, while others do not
• There is a huge comparison between benign tumors and malignant tumors (cancers)
• Paraneoplastic syndrome


  Symptoms/manifestations that happen in parallel with cancer
• Renal cell carcinoma (kidney cancer)


  • Typical presentation is a triad of flank pain, flank mass, and hematuria (blood in urine)
  • Other manifestations can occur due to anatomical and pathophysiological correlations
• Anatomical correlation of renal cell carcinoma

  1. Metastasis to left renal vein

  2. Inability of left testicular vein to drain into left renal vein

  3. Swelling of left testicle (varicocele)
• Right kidney cancer metastasizing to right renal vein

  No effect on right testicle as it drains directly to inferior vena cava
• Left kidney cancer metastasizing to left renal vein

  Blockage of left testicular vein drainage, leading to swelling of left testicle (varicocele)
• Paraneoplastic manifestations of renal cell carcinoma

  • Excessive secretion of erythropoietin (EPO) leading to polycythemia/erythrocytosis
  • Secretion of parathyroid hormone-related peptide leading to hypercalcemia
• The negative feedback mechanism is not working properly in the paraneoplastic manifestations of renal cell carcinoma
• Renal cell carcinoma can secrete parathyroid hormone-related peptide, which raises serum calcium levels
• Elevated serum calcium levels from parathyroid hormone-related peptide can lead to decreased nerve excitability, causing fatigue, lethargy, and drowsiness in the patient
• Renal cell carcinoma can also secrete excessive amounts of ALT, similar to liver conditions
• Some cancers can secrete excessive erythropoietin (EPO) as part of paraneoplastic syndrome
• Squamous cell lung cancer can secrete parathyroid hormone-related peptide, raising serum calcium levels
• Small cell lung cancer can secrete adrenocorticotropic hormone, leading to Cushing's syndrome, and antidiuretic hormone, leading to syndrome of inappropriate ADH and hyponatremia
• Pancreatic cancer can lead to paraneoplastic syndromes like superficial migratory thrombophlebitis and nonbacterial thrombotic endocarditis
• Gastric cancer can lead to paraneoplastic syndromes like acanthosis nigricans, seborrheic keratosis, and nephrotic syndrome
• Laser sign, an explosive eruption of multiple seborrheic keratosis lesions, can indicate an underlying visceral malignancy like gastrointestinal, lung, or breast cancer
• Other paraneoplastic syndromes include too syndrome, Sister Mary Joseph nodule, acrokeratosis paraneoplastica, and tripe palms
• Pre-neoplastic syndrome refers to conditions that may lead to the development of cancer, while paraneoplastic syndrome refers to conditions caused by the presence of a cancer