GC: n

CT: Paraneoplastic syndromes may be the first or most prominent manifestation of a cancer. When a patient without a known cancer presents with one of the “typical” paraneoplastic syndromes, a diagnosis of cancer should be considered and investigated. Because of their protean manifestations, paraneoplastic syndromes should be managed by a coordinated team of physicians, including medical oncologists, surgeons, radiation oncologists, endocrinologists, hematologists, neurologists, and dermatologists.
S: MD – http://emedicine.medscape.com/article/280744-overview (last access: 17 May 2017)

N: – paraneoplastic (adj): From prefix “para-” (before vowels, par-, word-forming element meaning “alongside, beyond; altered; contrary; irregular, abnormal,” from Greek para- from preposition “para” “beside, near, issuing from, against, contrary to,” from PIE *prea, from root *per- “forward,” hence “toward, near, against”; cognate with Old English for- “off, away”) and adjective “neoplastic” (neo- + -plastic, after neoplasm), first known use: 1871.
– syndrome (n): “A number of symptoms occurring together,” 1540s, from medical Latin, from Greek syndrome “concurrence of symptoms, concourse of people,” from syndromos “place where several roads meet,” literally “a running together,” from syn– “with” + dromos “a running, course”. Psychological sense is from 1955.

2. A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor. Paraneoplastic syndromes are typical among middle aged to older patients, and they most commonly present with cancers of the lung, breast, ovaries or lymphatic system (a lymphoma). Sometimes the symptoms of paraneoplastic syndromes show before the diagnosis of a malignancy, which has been hypothesized to relate to the disease pathogenesis. In this paradigm, tumor cells express tissue-restricted antigens (such as neuronal proteins), triggering an anti-tumor immune response which may be partially or, rarely, completely effective in suppressing tumor growth and symptoms. Patients then come to clinical attention when this tumor immune response breaks immune tolerance and begins to attack the normal tissue expressing that (e.g. neuronal) protein.

3. Symptoms: Difficulty walking, difficulty maintaining balance, loss of muscle coordination, loss of muscle tone or weakness, loss of fine motor skills, such as picking up objects, difficulty swallowing, slurred speech or stuttering, memory loss and other thinking (cognitive) impairment, vision problems, sleep disturbances, seizures, hallucinations, unusual involuntary movements.

4. Causes: Paraneoplastic syndromes are not caused by cancer cells directly disrupting nerve function, by the cancer spreading (metastasis), or by other complications such as infections or treatment side effects. Instead, they occur alongside the cancer as a result of the activation of your immune system.
Researchers believe paraneoplastic syndromes are caused by cancer-fighting abilities of the immune system, particularly antibodies and certain white blood cells, known as T cells. Instead of attacking only the cancer cells, these immune system agents also attack the normal cells of the nervous system and cause neurological disorders.

5. Cultural Interrelation: Paraneoplastic syndromes are fairly common on House, M.D., occurring in many epiosodes where cancer is the final diagnosis. However, many critics of the series, including the popular medical blog about House Polite Dissent, have noted that paraneoplastic syndromes, which are in any event rare even when a patient has cancer (roughly 1% of cancer patients exhibit such syndromes), are too often used as a way of explaining the patient’s symptoms that can’t be explained by the underlying cancer.

S: 1. Etymonline – http://www.etymonline.com/index.php?allowed_in_frame=0&search=para; http://www.etymonline.com/index.php?allowed_in_frame=0&search=neo (last access: 17 May 17, 2017); MW – https://www.merriam-webster.com/dictionary/neoplastic (last access: 19 March 2018); Etymonline – http://www.etymonline.com/index.php?term=syndrome (last access: 17 May 2017). 2. MEDICALDICT – http://encyclopedia.thefreedictionary.com/paraneoplastic+syndrome (last access: 17 May 2017). 3 & 4. MAYO – http://www.mayoclinic.org/diseases-conditions/paraneoplastic-syndromes/symptoms-causes/dxc-20315138 (last access: 17 May 2017). 5. http://house.wikia.com/wiki/Paraneoplastic_syndrome (last access: 19 March 2018).

CR: neoplasia, neoplastic, syndrome.