Paraneoplastic Syndromes

Strange and bizarre problems cancer can cause

By Eva Briggs

Cancer is a dreaded disease that nobody wants. Actually, cancer isn’t just one disease; there are more than 200 types. Many people are familiar with the seven warning signs of cancer, which I’ll review. I’m also going to write about some strange and bizarre things cancer can do: paraneoplastic syndromes.

First a recap of seven common warning signs of cancer:

1. Change in bowel or bladder habits. 

2. A sore that does not heal. 

3. Unusual bleeding or discharge. 

4. Thickening or lump in the breast or elsewhere. 

5. Indigestion or difficulty in swallowing.

6. Obvious change in a wart or mole.

7. Nagging cough or hoarseness.

Paraneoplastic syndromes (PNS) are symptoms distant from where the cancer arises. They’re not caused by a tumor growing or pushing on nearby tissues. They arise when a cancer secretes substances that travel elsewhere in the body. If the patient develops PNS before their cancer is diagnosed, it can be challenging to recognize.

The most common organ systems affected by PNS are the endocrine (hormone) system, immune system, skin and neurologic system.

Endocrine effects occur when a cancer creates a substance that is either a hormone or similar enough to a hormone to act like one. PNS development doesn’t correlate with the stage of the cancer or its prognosis. Most improve when the underlying tumor is treated. But additional treatment directed at the endocrine abnormality is also needed.

Some typical endocrine PNS include:

• SIADH. The acronym stands for syndrome of inappropriate antidiuretic hormone secretion. The effect is the opposite of taking a water pill. The kidneys hang on to extra water instead of excreting it. This dilutes the salts in the blood causing headaches, falls, nausea, muscle cramps and in severe cases confusion and coma.

Hypercalcemia. This means too much calcium in the bloodstream, It can cause mental changes, weakness, nausea and vomiting, high blood pressure and slowed heart rate.

Cushing’s syndrome. This results from too much cortisol, which leads to weight gain, weakness, high blood pressure and leg swelling.

Hypoglycemia. Low blood sugar levels causes sweating, weakness, nausea, anxiety, tremors, confusion, and when severe, coma.

• In neurologic PNS, the body produces onconeural antibodies, which attempt to fight the cancer. They are directed against tumor substances that resemble nervous system components, and therefore attack the nervous system as well. Once the body has begun producing these onconeural antibodies, they often linger after the cancer is treated. So their treatment requires drugs that suppress the immune system. Depending upon which part of the nervous system is affected, symptoms might include trouble thinking, personality changes, balance problems, problems with the nerves controlling the face and head, weakness, or numbness.

• Skin and rheumatologic PNS include syndromes that often also occur in the absence of any underlying cancer. Some typical conditions include:

Acanthosis nigricans. Darkened and thickened skin, often on the neck and armpits, that also may be associated with diabetes.

Dermatomyositis. Rash on the face as well as on shoulders, upper back and upper chest. There is associated muscle weakness, muscle pain and trouble swallowing and breathing.

Erythroderma. Red, peeling, itching rash.

Leukocytoclastic vasculitis. Bruises that are palpable (can be felt) on the legs, kidney impairment, and nerve damage in the extremities (peripheral neuropathy). My own father developed this when he had leukemia.

Paraneoplastic pemphigus. Severe blisters on the skin and erosions in the mucus membranes such as inside the mouth.

Polymyalgia rheumatic. Muscle pain and stiffness of the shoulders and hips.

Sweet syndrome. Tender red nodules on the face, extremities, and upper trunk, often with fever and pus. Lesions can resemble boils.

And that is just a brief description of some of the things cancer can do.

You can’t prevent all cancers, but giving up smoking, eating a healthy diet, getting regular exercise and getting age-appropriate cancer screening can reduce your risk.

Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.