What Are The First Symptoms Of Paraneoplastic Syndrome & How Do You Test For It?

Paraneoplastic syndrome is caused by an altered response to a neoplasm (a specific type of cancer tumor) in the immune system. It is a rare disorder. The clinical syndrome involves systemic non-metastatic effects, which are usually followed by malignancy.(1) It can be the most notable and the first manifestation of malignant cells. It is a type of syndrome that results from malignancy in your body but is not caused by the presence of local cells of cancer. So it is quite different from the mass effect.

The syndrome is typically seen among elderly and middle-aged individuals suffering from breast, lymphatic, ovarian or lung cancer. Although it usually affects the nervous system often other organs of the body may also get affected. These include the joints, blood, skin, and hormone system. The syndrome takes place once the body’s immune system fighting cancer cells start attacking the other parts of the body, such as muscle cells, peripheral nerves, spinal cord, and brain.(2)

What Are The First Symptoms Of Paraneoplastic Syndrome?

What Are The First Symptoms Of Paraneoplastic Syndrome?

Paraneoplastic syndromes may lead to issues with coordination and movement of muscles, memory or reasoning or thinking abilities, sensory perception, and sleeping disorder depending on the extent of the impact on the nervous system.(3) The symptoms usually appear even before the malignancy gets diagnosed.(1)

In several cases, the nervous system injury may be reversed with the immune system and cancer-directed therapy. But the disorder can quickly lead to severe, irreversible nervous system damage as well.

The usual symptoms of the paraneoplastic syndrome affecting your nervous system may develop rather rapidly. In fact, it may progress within a few days or weeks. These symptoms often start even before the diagnosis of cancer.(3)

Common symptoms include:

The symptoms of the disorder are similar to some other conditions such as malignancy, complications in cancer, and cancer therapies. Early diagnosis and onset of treatment are important to minimize the damage and if possible, reverse the injury.(4) So, if you are having some of the above-mentioned symptoms, seek medical help at the earliest.

How Do You Test For Paraneoplastic Syndrome?

Usually, doctors conduct physical examination followed by blood tests to diagnose the paraneoplastic syndrome. However, you may be requested to undergo imaging tests and a spinal tap to confirm the syndrome.(2)

Common Clinical Examinations: A neurological examination is usually done during a physical examination. The doctor may ask you different questions to assess your thinking and reasoning skills. The doctor will check your:

  • Balance
  • Coordination
  • Memory
  • Mood
  • Muscle strength
  • Muscle tone
  • Reflexes
  • Sense of touch
  • Vision and hearing

Laboratory Tests: The laboratory tests include blood examination and spinal tap, where cerebrospinal fluid (CSF) is taken through a lumbar puncture. Blood tests examine the antibodies commonly related to paraneoplastic syndrome. Blood tests to identify nutritional or hormonal disorders and possible infection may also be conducted. These are done to specifically identify the cause of the symptoms.(4)

Lumbar puncture is done to get CSF, a fluid that helps to provide a cushion in the spinal cord and brain. A small quantity of CSF is removed with the help of a needle inserted into the lower section of the spinal cord. This test is done as paraneoplastic antibodies are often located in CSF, but not in blood.(3)

Imaging Tests: Imaging tests are done to determine the presence of a tumor that may be responsible for these symptoms. Some of the common imaging tests performed are:

Conclusion

The paraneoplastic syndrome can cause irreversible damage to the nervous system of the patient in a quick time. Timely intervention with treatment directed towards the immune system disorder and the associated malignancy can avoid more damage and contribute to a better standard of living with improved symptoms.

References:

  1. Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Paper presented at: Mayo Clinic Proceedings 2010.
  2. Graus F, Delattre J, Antoine J, et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. Journal of Neurology, Neurosurgery & Psychiatry. 2004;75(8):1135-1140.
  3. Honnorat J, Antoine J-C. Paraneoplastic neurological syndromes. Orphanet journal of rare diseases. 2007;2(1):22.
  4. Spiro SG, Gould MK, Colice GL. Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines. Chest. 2007;132(3):149S-160S.
  5. Linke R, Schroeder M, Helmberger T, Voltz R. Antibody-positive paraneoplastic neurologic syndromes: value of CT and PET for tumor diagnosis. Neurology. 2004;63(2):282-286.

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