Paraneoplastic Syndromes

Written by Michael Kerry

There are complex symptoms of lung cancer that may show up as Neoplastic and Paraneoplastic syndromes. Syndromes are collections of symptoms and physical signs that if put together, follow a pattern.

Paraneoplastic Syndromes

We will explore some of the paraneoplastic syndromes as related to lung cancer. These paraneoplastic syndromes are described as “rare disorders caused by the secretions of a tumor or metastases.” In other words, a tumor or metastases secretes substances that end up causing one of these rare disorders.

There are several sets of symptoms that can affect different parts of the body, but some of these disorders can be neurological - affecting the nerves or nervous system, endocrine – affecting the hormones or glands, or cutaneous – affecting the skin. As with so many of the signs and symptoms of lung cancer, the appearance of these syndromes can also be associated with illnesses other than lung cancer. Some of these syndromes can occur as a side-effect to medication.

Cutaneous Example

One such disorder is Clubbing. This is a thickening of the flesh under the toe or fingernails—with the nail curving down, showing a rounded upside-down spoon like- shape. Clubbing can be caused by several different diseases and even by family genes. But it can also be caused by lung cancer.

Hypercalcemia

Another of the rare disorders caused by the secretions mentioned above is Hypercalcemia, which is considered one of the most common life threatening disorders that show up with cancer.

Hypercalcemia is caused when the calcium in the blood gets too high. Usually people take in the same amount of calcium that is expelled through urine, feces, and sweat. Those with lung or breast cancer tumors or metastases, that secrete this substance, will somehow retain the calcium, causing the calcium level in the blood to get out of hand.

As with so many things connected with lung cancer and cancers in general, this is hard to detect. The symptoms are non-specific and include nausea, lack of appetite, thirst. There are so many diseases that these symptoms go with.

Endocrine Example

Another syndrome of paraneoplastic is inappropriate antidiuretic hormone. This is a condition where the body holds an excess of water and there is a decrease of sodium or salt concentration because of a mix-up of improper chemical signals. Patients that have this syndrome can become severely ill or can have no symptoms at all. The syndrome can also be caused by reasons other than Lung Cancer. This syndrome is also a factor in Head Injuries, as a reaction to some medications and drugs, and can occur because of certain infections in the body. There are other causes of the disease.

Pancoast Syndrome

The Pancoast syndrome or superior sulcus tumors are another of the paraneoplastic syndromes. These tumors seem to be caused by a bronchogenic carcinoma which is a non small cell lung cancer. They are rarer than some of the other syndromes, affecting a small 5% of lung cancer patients. The symptoms can include constriction of the pupils, a pronounced lack of sweating, eyelids drooping or the eyeball sunken eyeball. There can also be pain or weakness in the hand and arm.

Vena Cava Syndrome

The last of the paraneoplastic syndromes we will discuss is the superior vena cava syndrome. The two major veins that send blood to the right atrium of the heart are called the superior vena cava - or upper vein, and the lower or inferior vena cava vein.

Vena Cava Syndrome affects the upper or superior vena cava that carries the blood of the upper body back to the heart. The superior vena cava syndrome is the combination of symptoms that happen when the upper vein becomes partly blocked. Superior vena cava syndrome is usually caused by cancer, either lung cancer or non-Hodgkin lymphoma. This happens when a lung cancer metastases and causes a tumor in the chest or the lymph nodes to swell pressing against the superior vena cava and causing a blockage.

The symptoms for this syndrome would be difficulty breathing, coughing, and swelling of the upper body, face, neck and arms. Lesser symptoms might be pain in the chest, a hoarse voice, or swollen veins in the neck and chest. There can be a bluish color to the skin or a drooping eyelid.

There are other situations besides cancer that can cause the superior vena cava syndrome, however lung cancer is the most prevalent cause.

Lung Cancer Diagnosis is Difficult

We can begin to see why lung cancer is so difficult to diagnose when nearly all of the symptoms or connected illnesses either don’t show symptoms until the problem is well advanced, or the symptoms can be for so many other illnesses. There is no specific set of symptoms that point to Lung Cancer. Often diagnosis occurs when everything else is ruled out.

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