Imagine, someone has been feeling very unwell for a few days, their memory is a bit fuzzy, their joints sometimes hurt, and their skin starts to itch. So when you go to a doctor for something like this, and they do various tests, they find out that the root of all this is a cancer hidden inside the body. Isn't it amazing? The cancer is in one place, but due to its effects, symptoms that seem completely unrelated appear in completely different parts of the body. That's what we call Paraneoplastic Syndrome in medicine.
Simply put, what is Paraneoplastic Syndrome?
This may seem a little complicated to understand, but let's keep it simple. When a malignant tumor develops in your body, there are direct effects. For example, if you have lung cancer, you may have a cough. If you have colon cancer, you may have blood in your stool. These are the direct symptoms of cancer.
But Paraneoplastic Syndrome is something different. What happens here is that your body produces a collection of other symptoms in response to the cancer. That is, it is not something that the cancer does directly, but because the cancer is in the body, other systems in the body go haywire as a 'response' to it.
There are two main ways this can happen:
1. Autoimmune Response: Think of our body's immune system as an army defending a country. Cancer cells are an enemy that has entered the country. So our army (immune system) starts fighting against this enemy (cancer). For that, they produce special weapons, that is , antibodies . But sometimes, during this fight, our army makes a mistake. They start attacking not only enemy cells, but also good, healthy cells in our own body, thinking that they are enemies. For example, they can attack cells in the nervous system, skin cells, or cells in the joints. That is when the symptoms related to those organs appear.
2. Hormone production by cancer cells: Some types of cancer can produce excessive amounts of substances, such as hormones, that our body does not normally produce, or produces very little of. These abnormal hormones accumulate in the blood and travel throughout the body, disrupting the functioning of various organs. For example, these hormones can cause blood pressure to rise excessively, or calcium levels to rise in the blood.
The important thing is that sometimes, even before cancer is diagnosed, the symptoms related to this Paraneoplastic Syndrome appear first. Therefore, it is very important to be aware of these symptoms.
What parts of the body are affected by this condition?
Paraneoplastic syndromes can affect almost any system in the body. However, they are most commonly seen in these systems. Let's take a look at what they are and what conditions can occur related to them.
| Body system affected | Possible medical conditions (examples) |
|---|---|
| Nervous system (brain, spinal cord, nerves) | Conditions like Cerebellar degeneration, Encephalitis, Lambert-Eaton myasthenic syndrome, Myasthenia gravis, Peripheral neuropathy, Stiff person syndrome. |
| Endocrine system (hormones) | Conditions such as Cushing syndrome, Hypercalcemia (increased calcium in the blood), and Carcinoid syndrome. |
| Connective tissue (bones, joints, muscles) | Dermatomyositis, Paraneoplastic polyarthritis (joint inflammation), Hypertrophic osteoarthropathy. |
| Blood | Anemia of chronic disease, Paraneoplastic erythrocytosis, Paraneoplastic thrombocytosis. |
| Skin | Acanthosis nigricans (thickening and thickening of the skin in places such as the armpits and neck), Dermatomyositis, Sweet syndrome, Paraneoplastic pemphigus. |
What are the common and specific symptoms?
There are several common symptoms that are first seen in a paraneoplastic syndrome. These can also be seen in any other disease, so it is not a good idea to panic just by seeing these.
Common symptoms:
- Fever without reason
- Appetite
- Excessive sweating at night
- Unusual weight loss without effort
In addition to these common symptoms, as we discussed earlier, specific symptoms arise depending on the body system affected.
| Affected system | Specific symptoms that may be seen |
|---|---|
| Nervous system | Difficulty walking, loss of balance, dizziness, double vision, memory loss, dementia, muscle weakness, difficulty speaking. |
| Endocrine system | High blood pressure, unexplained weight gain, high blood sugar levels, extreme fatigue. |
| Connective tissue | Joint pain, joint swelling, muscle pain and weakness. |
| Blood | An abnormal decrease or increase in a type of blood cell (e.g. anemia, or increased tendency for blood to clot). |
| Skin | Non-cancerous lumps on the skin, redness of the skin, excessive itching, and changes in skin color. |
Who is at higher risk of developing this condition?
Paraneoplastic syndromes are theoretically possible for anyone with cancer. However, they are more likely to occur with certain types of cancer. According to statistics, about 8 out of 100 cancer patients (8%) develop this condition.
The types of cancer most commonly associated with this condition are:
- Lung cancer (most commonly seen with this type)
- Breast cancer
- Blood-related cancers (such as lymphoma, leukemia)
- Ovarian cancer
How does a doctor find this?
When you go to see a doctor with these symptoms, the first thing he or she will do is take a thorough history and do a physical exam. Then, they will order several tests to determine if the symptoms are caused by cancer or another medical condition.
- Blood tests: Routine blood tests can check for other causes of your symptoms (e.g., infections, hormonal imbalances). Also, some specialized blood tests can look for antibodies or tumor markers related to a paraneoplastic syndrome.
- Imaging: Tests such as CT scan , MRI scan , or ultrasound are used to find out if there is a cancerous tumor inside the body.
- Neurological exam: If your symptoms are suspected to be related to the nervous system, your doctor will perform various activities to test your strength, memory, balance, and coordination.
- Spinal tap/Lumbar Puncture: This involves taking a small amount of cerebrospinal fluid, the fluid that surrounds your spinal cord, and testing it to see if there are any abnormal antibodies in the fluid that are attacking healthy cells.
How is it treated?
The most important and fundamental thing in treating a paraneoplastic syndrome is to treat the cancer that caused it all. Once the cancer is controlled or cured, the symptoms associated with the paraneoplastic syndrome often subside on their own.
At the same time, during cancer treatment, treatments are also given to control the symptoms that have arisen. The main goal of these treatments is to calm the immune system, which mistakenly attacks healthy cells.
- Corticosteroids: Drugs like Prednisolone. These work by reducing inflammation and swelling in the body.
- Immunosuppressants: These drugs reduce the activity of the immune system and stop it from attacking healthy cells.
- Intravenous immunoglobulin (IVIG): This involves giving a substance containing antibodies taken from healthy people intravenously. These antibodies help destroy bad antibodies that are damaging the body.
- Plasmapheresis: This is a process similar to blood purification. Your blood is taken, the liquid part (plasma) is separated, harmful antibodies are filtered out, and the purified plasma is re-infused into your body.
- Physical, occupational and speech therapy: If the nervous system has been affected and there is difficulty walking, talking or performing daily tasks, these treatments can help rebuild those abilities.
When should you see a doctor?
If you have any unusual symptoms like those mentioned in this article, especially if they are severe or last more than two weeks, you should definitely see a doctor.
Remember, not everyone who has these symptoms has cancer. Many of these symptoms can also be caused by other conditions that are not as serious as cancer. So don't assume the worst and panic. However, it's important to find out exactly what's causing it. So be sure to seek medical advice.
If you have been treated for cancer in the past, say within the past five years, and are now experiencing symptoms like these, it is very important to get tested again. This can help determine if the cancer has returned.
When you live with cancer, it's normal to feel overwhelmed when you have a combination of symptoms like these. But it's important to understand that the best treatment for this paraneoplastic syndrome is the same as the treatment for the cancer. Following your cancer treatment plan closely will go a long way in helping you manage these symptoms. There are many treatments that can provide you with relief. Talk openly with your doctor about them.
Take-Home Message
- Paraneoplastic syndrome is not a direct effect of cancer, but rather an indirect effect caused by the body's immune system or hormones in response to cancer.
- In some cases, symptoms related to this syndrome appear first , even before cancer is diagnosed.
- The main way to treat this condition is to treat the underlying cancer.
- If you have unusual symptoms (e.g. weight loss, muscle weakness, skin changes) that appear for no reason and last more than two weeks, see a doctor without delay.
- Since these symptoms can be caused by many other medical conditions, it is important not to panic and seek a proper medical examination .
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