Paraneoplastic syndrome – a complex of the clinical and laboratory symptoms of an oncological disease which are not connected with growth of primary new growth and emergence of metastasises. It is caused by nonspecific reaction of an organism and allocation by a tumor of biologically active connections. It is shown by the endocrine, dermatological, cardiovascular, neuromuscular, nephrological, gastroenterologichesky, hematologic or mixed frustration. It is diagnosed on the basis of the anamnesis, symptoms and these additional researches. Treatment – removal or conservative therapy of primary tumor.
Paraneoplastic syndrome – not metastatic system clinical laboratory displays of an oncological disease. Suffer mainly sick advanced and middle age. The paraneoplastic syndrome arises at a lymphoma, lung cancer, ovarian cancer and a breast cancer more often. Sometimes becomes the first sign of earlier not diagnosed oncological defeat. Plays both a positive, and negative role in the course of diagnosis of oncological diseases.
In the absence of clinical manifestations of primary oncological process becomes a nonspecific marker of a new growth. At the same time, simultaneous emergence of a paraneoplastic syndrome and local symptoms of a malignant tumor can complicate a clinical picture and complicate recognition of an oncological disease. Treatment experts in the field of oncology, endocrinology, cardiology carry out, gastroenterologies, dermatology and doctors of other specialties.
Reasons of a paraneoplastic syndrome
Activity of a malignant tumor and reaction of an organism to this activity are the main reasons for development of a paraneoplastic syndrome. Cages of a new growth secrete biologically active proteins, enzymes, immunoglobulins, prostaglandins, tsitokina, interleykina, growth factors, active and inactive hormones influencing activity of various bodies and systems. The contact of normal body tissues with fabric of a tumor and the connections allocated by it provokes normal immune reactions and causes development of autoimmune violations.
The probability of emergence, intensity of manifestations and character of a paraneoplastic syndrome depend on localization and a type of a new growth, ability of a tumor to emit various active agents and genetically caused tendency to autoimmune violations. Most often the paraneoplastic syndrome develops at lung cancer. Among other oncological diseases which are often provoking this syndrome – a breast cancer, ovarian cancer, cancer of a kidney, a lymphoma, leukoses, a gepatotsellyulyarny carcinoma, stomach cancer, a pancreatic cancer and tumors of TsNS.
Characteristic of paraneoplastic syndromes
Paraneoplastic syndromes – extensive group of the syndromes arising at malignant tumors. Besides, paraneoplastic syndromes come to light at some good-quality new growths and diseases of not tumoral nature, including – at rheumatic diseases, chronic nonspecific diseases of lungs, heart troubles, endocrine diseases and defeat of parenchymatous bodies. The possibility of involvement of any bodies and systems, and also a variety of clinical manifestations of paraneoplastic syndromes complicate creation of uniform classification.
There are several options of ordering of such syndromes, the most widespread of which is the group by organ system principle (taking into account defeat of these or those bodies). According to this option, distinguish endocrine/metabolic, dermatological, kidney, nervouslymuscular/neurologic and some other types of paraneoplastic syndromes. Distinctive features of all syndromes are:
- general pathogenetic mechanisms;
- emergence at oncological diseases;
- not specificity of clinical symptomatology and laboratory indicators;
- possibility of development of a paraneoplastic syndrome before emergence of local symptoms of a tumor, along with local symptoms of a tumor or at final stages of a disease;
- inefficiency of therapy, disappearance of a syndrome after radical treatment of a new growth and its repeated emergence during the recurrence.
Development of a paraneoplastic syndrome before emergence of local symptoms of a tumor can, both to facilitate, and to complicate diagnosis of the main pathology. For example, Mari-Bambergera's syndrome (ossifitsiruyushchy system at which fingers take a form of drum sticks) is more often observed at malignant damages of a pleura and lungs, but is not their specific manifestation as it can be found also at other diseases, for example, at chronic obstructive bronchitis, cirrhosis or heart diseases.
Nevertheless, existence of this paraneoplastic syndrome indicates high probability of pathology of respiratory system and allows to define the list of necessary inspections rather precisely. Other paraneoplastic syndromes, for example, fever, thrombophlebitis or dermatological defeats can be treated as independent diseases that conducts to not additional examination, purpose of the wrong treatment and overdue identification of the oncological defeats which became the reason of development of this pathology. Timely diagnostics and differential diagnostics of this group of pathological states remains an urgent problem of modern oncology.
Types of paraneoplastic syndromes
Gastrointestinalny paraneoplastic syndromes (appetite loss, weight loss) – the most widespread syndromes at oncological diseases. At certain stages of malignant process come to light practically at all patients. The main manifestations of a paraneoplastic syndrome are appetite loss, taste change, emergence of disgust for some food tastes and smells. After diagnosis, progressing of local symptomatology and the beginning of chemotherapy gastrointestinalny frustration can be aggravated with a depression, fear of nausea and vomiting, violations of passability of intestines and other circumstances.
Hematogenic paraneoplastic syndromes come to light at most of oncological patients. The most widespread kind of this paraneoplastic syndrome is the moderated or unsharply expressed normokhromny anemia. In the analysis of peripheral blood other symptoms of the main disease quite often are found: increase in SOE, and shift of a leykotsitarny formula to the left. At V-cellular lymphoid new growths the paraneoplastic syndrome can be shown by autoimmune hemolytic anemia, at a melanoma and Hodzhkin's lymphoma – granulotsitozy, at leukoses – thrombocytopenia, at cancer of a liver and kidneys – eritrotsitozy.
Endocrine and metabolic paraneoplastic syndromes include various hormonal and exchange violations. At medullary cancer of a thyroid gland the gipokaltsiyemiya proceeding asymptomatically or which is followed by increase in neuromuscular excitability can develop. At melkokletochny cancer of a lung the paraneoplastic syndrome is shown by Cushing's syndrome and water and electrolytic violations. For feokhromotsity increase in arterial pressure, is characteristic of Hodzhkin's lymphoma – a gipourikemiya, of a gematosarkoma and sharp leukoses – a giperurikemiya.
Vascular paraneoplastic syndromes are usually shown by thrombophlebitises. Can arise several months prior to emergence of the first symptoms of an oncological disease. Most often come to light at a breast cancer, GIT tumors, lung cancer and ovarian cancer. A half of trobmoflebit at patients are aged more senior than 65 years are connected with development of malignant new growths. Vascular paraneoplastic syndromes badly give in to antiagregantny therapy. After surgeries develop more than at a half of patients with oncological diseases. Are the reason of a lethality, the third on prevalence, in the postoperative period.
Dermatological paraneoplastic syndromes differ in a big variety. Include a passing eritema, the acquired ichthyosis, a paraneoplastic puzyrchatka and other frustration. Come to light at leukoses, medullary cancer of a thyroid gland and some other oncological diseases.
Neurologic / paraneoplastic syndromes are followed by defeat of the central and peripheral nervous system. Can be shown by encephalitis, dementia, psychoses, Lambert-Eaton's syndrome (the weakness of muscles of extremities reminding a myasthenia at preservation of a tone of eye muscles; usually arises at tumors in the area to a thorax, most often at lung cancer), a syndrome to Giyena-Barra (peripheral neuropathy, comes to light at some patients with Hodzhkin's lymphoma) and other peripheral neyropatiya.
Rheumatologic paraneoplastic syndromes meet both at rheumatoid diseases, and at malignant new growths. The system sclerosis, a polimialgiya and rheumatoid arthritis are characteristic of gemoblastoz and tumors of a large intestine. The paraneoplastic syndrome in the form of a secondary amiloidoz comes to light at kidney and cellular cancer, lymphoma and a myeloma. The hypertrophic osteopathy can be observed at some kinds of cancer of lung.