Paraneoplastic syndrome: Difference between revisions

	Paraneoplastic syndrome Microchapters
Patient Information
Overview
Classification Endocrine Musculocutaneous Neurological Hematological Others
Causes
Differential diagnosis

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Latest revision as of 15:14, 14 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]
Synonyms and keywords: Paraneoplastic syndrome

Overview

Paraneoplastic syndromes are a rare type of disease that is caused by abnormal immune systems resulting from cancerous cells. Paraneoplastic syndromes are disorders due to the release of hormones, or peptides that cause immune cross-reactivity between cancerous cells and normal tissues. Sometimes the symptoms of paraneoplastic syndromes show even before the diagnosis of a malignancy. There is no screening for paraneoplastic syndromes. The stage and type of diagnosis of cancer determine the prognosis of a paraneoplastic syndrome. The causes are mostly related to the organ affected. The paraneoplastic syndromes are divided into four main categories such as musculocutaneous, neurological, hematological and endocrines. They are no cures for the paraneoplastic syndrome, but cancer treatment and some medications to reduce autoimmune responses are helpful.

Classification

Paraneoplastic syndromes may be classified into 5 main categories accordingly:


Type of paraneoplastic syndrome	Subtype	Associated Cancers
Endocrine	Hypercalcemia^[1]	Breast cancer and lung cancer (typically squamous cell) due to the production of PTHrP (Parathyroid hormone-related protein)multiple myeloma, renal cell carcinoma, ovarian cancer, endometrial cancer, and lymphoma
	SIADH^[2]	Small-cell lung cancer, mesothelioma, breast, prostate, adrenal, urethral, thymoma, lymphoma, GI, CNS, and Ewing sarcoma
	Ectopic ACTH secretion^[3]	Small-cell lung cancer, carcinoid tumor, thymoma, medullary carcinoma of the thyroid and other cancers
	Tumor induced osteomalacia^[4]	Metastatic breast cancer
	Hypoglycemia^[5]	GI cancers, mesothelioma, lung, real cancer, and sarcomas
Musculocutaneous	Dermatomyositis^[6]	Breast, ovarian, lung, and prostate cancer
	Leser-Trélat sign^[7]	Gastrointestinal adenocarcinomas (gastric, colon, rectal), breast cancer, lymphoproliferative disorders/lymphoma, and melanoma.
	Acanthosis nigricans^[6]	Gastric adenocarcinoma, endometrial cancer.
	Necrolytic migratory erythema^[8]	Glucagonoma
	Sweet's syndrome^[9]	Acute myelogenous leukemia, myeloproliferative disorders, lymphoproliferative disorders, myelodysplastic syndrome, and carcinoma
	Pyoderma gangrenosum^[10]	Rectal Adenocarcinoma, myeloproliferative disorders, colon cancer
Neurological^[11]	Paraneoplastic cerebellar degeneration^[12]	Breast and gynecological malignancies
	Encephalomyelitis^[13]	Bronchial cancer (typically small cell lung carcinoma)
	Limbic encephalitis^[14]	Lung cancer
	Brainstem encephalitis^[15]^[11]	Lung cancer, testicular cancer, neuroendocrine tumors
	Opsoclonus (involving eye movement)^[15]	Neuroblastoma, small cell lung cancer and gynecological tumors
	Encephalitis	Teratoma
	Polymyositis	Squamous cell lung cancer, breast cancer^[16]
	Autonomic neuropathy^[17]	Carcinomas,small cell lung cancer, thymoma
	Lambert-Eaton myasthenic syndrome (LEMS)	Small-cell lung cancer, prostate cancer, lymphomas, adenocarcinomas
	Myasthenia gravis	Thymoma
	Subacute (peripheral) sensory neuropathy	Small cell lung cancer, breast cancer, sarcomas, Hodgkin lymphoma, and ovarian cancer
Hematological^[11]	Granulocytosis^[18]^[19]	Lung cancer (particularly large cell lung cancer), gastrointestinal, brain, breast, renal, and gynecologic cancers
	Thrombocytosis^[20]	Ovarian cancer
	Pure red cell aplasia^[21]	Thymoma, lymphoma, leukemia
	Eosinophilia^[11]	Lymphomas, leukemias, lung, gastrointestinal, and gynecologic tumors
Others	Membranous glomerulonephritis^[22]	Lung cancer, prostate cancer, and hematologic malignancies

Causes

Common Causes

The major causes of paraneoplastic syndrome include:^[23]^[24]^[25]

Causes by Organ System

Paraneoplastic syndromes causes may be regrouped by organ system.^[26]^[27]

Dermatologic	Dermatomyositis Cutaneous T-cell lymphoma
Ear Nose Throat	Oropharyngeal cancer
Endocrine	Medullary thyroid cancer Adrenal cancer
Gastroenterologic	Pancreatic cancer Other GI cancers
Hematologic	Myeloproliferative disorders, Multiple myeloma, Melanoma Lymphoma HTLV-associated Lymphoma Hodgkin's lymphoma Chronic lymphocytic leukemia Cancers of the T-cells Adult T-cell leukemia Acute myeloid leukemia
Musculoskeletal/Orthopedic	Teratoma Sarcomas Ewing sarcoma
Neurologic	Brain Cancer
Obstetric/Gynecologic	Ovarian cancer Endometrial cancer
Oncologic	Breast cancer
Pulmonary	Small cell lung cancer Pancoast's tumour Oat cell carcinoma Non-small cell lung cancer Malignant Mesothelioma Bronchial carcinoid
Renal /Electrolyte	Renal cancer
Rheumatology /Immunology/Allergy	No underlying causes
Urologic	Ureteral cancer Prostate cancer Bladder cancer
Miscellaneous	Thymoma Testicular germ-cell tumors

Differential diagnosis

Paraneoplastic syndromes must be differentiated from others types of cancer depending on the location and type of organs.

	Symptoms			Physical examination			Lab Findings			Imaging			Histopathology
Diseases	Clinical manifestations						Para-clinical findings							Gold standard	Additional findings
	Symptoms			Physical examination			Para-clinical findings
													Histopathology
Small cell lung cancer^[28]^[29]	Cough Weakness	Weight loss Fatigue	Dyspnea GI symptoms	Lymphadenopathy	Digital clubbing	Bone tenderness	↑ Ca++	Hyponatremia	_	Chest CT Scan: Necrotic and hemorrhagic hilar mass and lymphadenopathy	Chest X-ray: Hilar mass	_	Small, round and oval cells Necrosis	Biopsy	_
Squamous lung cancer^[30]	Asymptomatic at first	Chronic cough Dyspnea Weakness	Weight loss Fatigue Hemoptysis	Confusion Lymphadenopathy	Decreased breath sound in lung auscultation	Fingers clubbing	↑ Ca++	_	_	Chest Ct scan : Ground glass opacity	Chest X-ray: Spiculated Mass, bulky hilum	_	Intracellular bridges Central necrosis with cavitation	Biopsy	_
Hepatocellular carcinoma^[31]^[32]	Asymptomatic at first	Fatigue Abdominal pain Nausea Vomiting Fever	Loss of appetite Pruritus yellow discoloration of skin	Jaundice Cachexia	Splenomegaly	Abdominal swelling with fluid shift	Prolonged PT	↑ Alpha fetoprotein	_	_	_	U/S : Small hypoechoic lesion Irregular border with fibrosis, and calcification	Polygonal tumor cells Granular eosinophilic cytoplasm	Biopsy	_
Diseases	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	Physical exam 2	Physical exam 3	Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3	Histopathology	Gold standard	Additional findings
Breast cancer^[33]^[34]^[35]	Lump in the breast Nipple discharge	Bone pain Weight loss	Loss of appetite Shortness of breath	Enlarged Supraclavicular lymph nodes	Dimpling of skin Inverted nipples	Bloody nipple discharge Change in personality	_	_	_	Mammogram: Soft tissue mass Microcalcification	_	_	Numerous mitotic figures Pleomorphism	Biopsy	_
Renal cancer^[36]^[37]^[38]^[39]	Hematuria Flank pain	Weight loss Loss of appetite	Abdominal mass Fatigue	Cachexia Abdominal bruit Palpable abdominal mass	Supraclavicular lymphadenopathy	High blood pressure Pallor	↑ Ca++ Polycythemia ↑ Platelets	↑ ALP ↑ LFT ↑ LDH	↑ Creatinine ↑ Cancer cells in urine cytology	Abdominal CT scan: Thickened irregular walls neoplastic mass	_	_	Depends on the subtypes	Needle Biopsy	_
Pancreatic cancer^[40]^[41]^[42]^[43]	Epigastric pain Nausea Yellow discoloration of skin Dark urine	Weight loss Abdominal pain	Loss of appetite Greasy stools Lack of energy	Cachexia Migratory superficial thrombophlebitis on the skin	Abdominal distention and tenderness Left Supraclavicular lymphadenopathy	Palpable periumbilical mass	↑ Bilirubin	↑ ALP ↑ LFT	Low albumin and cholesterol	Abdominal CT scan: Pancreatic duct dilation Pancreatic atrophy Obstruction of common bile duct	_	U/S: hypoechoic mass	Small nuclei Pleomorphism Granular cytoplasm	Spiral CT scan with contrast	_
Gastric cancer^[44]^[45]^[46]^[47]	History of gastric ulcer Early satiety Hematemesis	Weight loss Loss of appetite	Difficulty swallowing Abdominal discomfort	Palpable abdominal mass	Left supraclavicular lymphadenopathy	_	↑ CA 19-9	Anemia	_	Abdominal CT scan: Thickened gastric wall Loss of rugal fold Mucosal irregularity Ulcerative lesion	_	Endoscopy: Ulcer	Irregular tubular structure Minimal stroma and cellular Pleomorphism Nucleus located at the periphery	Endoscopy and biopsy	Microangiopathic hemolytic anemia Hypercogulable state Menbranous nephropathy Polyarteritis nodosa Acanthosis nigricans
Lymphoma]^[48]^[49]	Weight loss Abdominal pain	Fever Fatigue	Night sweat	Lymphadenopathy	Hepatosplenomegaly	_	↑ ESR	↑ LDH	_	CT scan of abdomen, pelvic, and chest: for metastasis to distant organs	_	_	Depends on the type of lymphoma	Biopsy	_
Ovarian cancer^[50]^[51]	Asymptomatic at first	Abdominal pain Bloating	Early satiety Urinary frequency and urgency	Palpable adnexal mass Abdominal swelling with fluid shift	Leg swelling and tenderness	Diminished breath sound due to the effusion	↑ CA-125	↑ Ca++	_	Pelvic U/S: Solid irregular mass with irregular thick septation	Abdominal CT scan: findings depend on the subtypes	_	Nuclear pleomorphism Macronucleolus Eccentric nucleus Psammoma bodies Necrosis	Biopsy	Trousseau syndrome

References

↑ Stewart, Andrew F. (2005). "Hypercalcemia Associated with Cancer". New England Journal of Medicine. 352 (4): 373–379. doi:10.1056/NEJMcp042806. ISSN 0028-4793.
↑ Raftopoulos, Harry (2007). "Diagnosis and management of hyponatremia in cancer patients". Supportive Care in Cancer. 15 (12): 1341–1347. doi:10.1007/s00520-007-0309-9. ISSN 0941-4355.
↑ Barbosa, Sandrine Laboureau-Soares; Rodien, Patrice; Leboulleux, Sophie; Niccoli-Sire, Patricia; Kraimps, Jean-Louis; Caron, Philippe; Archambeaud-Mouveroux, Françoise; Conte-Devolx, Bernard; Rohmer, Vincent (2005). "Ectopic Adrenocorticotropic Hormone-Syndrome in Medullary Carcinoma of the Thyroid: A Retrospective Analysis and Review of the Literature". Thyroid. 15 (6): 618–623. doi:10.1089/thy.2005.15.618. ISSN 1050-7256.
↑ Florenzano, Pablo; Gafni, Rachel I.; Collins, Michael T. (2017). "Tumor-induced osteomalacia". Bone Reports. 7: 90–97. doi:10.1016/j.bonr.2017.09.002. ISSN 2352-1872.
↑ Nauck, Michael A.; Reinecke, Manfred; Perren, Aurel; Frystyk, Jan; Berishvili, Giorgi; Zwimpfer, Cornelia; Figge, Anja M.; Flyvbjerg, Allan; Lankisch, Paul G.; Blum, Werner F.; Klöppel, Günter; Schmiegel, Wolff; Zapf, Jürgen (2007). "Hypoglycemia due to Paraneoplastic Secretion of Insulin-Like Growth Factor-I in a Patient with Metastasizing Large-Cell Carcinoma of the Lung". The Journal of Clinical Endocrinology & Metabolism. 92 (5): 1600–1605. doi:10.1210/jc.2006-2573. ISSN 0021-972X.
↑ ^6.0 ^6.1 Thiers, B. H.; Sahn, R. E.; Callen, J. P. (2009). "Cutaneous Manifestations of Internal Malignancy". CA: A Cancer Journal for Clinicians. 59 (2): 73–98. doi:10.3322/caac.20005. ISSN 0007-9235.
↑ Gaduputi, Vinaya; Chandrala, Chaitanya; Tariq, Hassan; Kanneganti, Kalyan (2014). "Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer". Case Reports in Oncological Medicine. 2014: 1–3. doi:10.1155/2014/825929. ISSN 2090-6706.
↑ Tremblay, Catherine; Marcil, Isabelle (2017). "Necrolytic Migratory Erythema: A Forgotten Paraneoplastic Condition". Journal of Cutaneous Medicine and Surgery. 21 (6): 559–561. doi:10.1177/1203475417719051. ISSN 1203-4754.
↑ Cohen, Philip R.; Kurzrock, Razelle (1987). "Sweet's syndrome and malignancy". The American Journal of Medicine. 82 (6): 1220–1226. doi:10.1016/0002-9343(87)90229-4. ISSN 0002-9343.
↑ You, Hye Rin; Ju, Jae-Kyun; Yun, Sook Jung; Lee, Jee-Bum; Kim, Seong-Jin; Won, Young Ho; Lee, Seung-Chul (2018). "Paraneoplastic Pyoderma Gangrenosum Associated with Rectal Adenocarcinoma". Annals of Dermatology. 30 (1): 79. doi:10.5021/ad.2018.30.1.79. ISSN 1013-9087.
↑ ^11.0 ^11.1 ^11.2 ^11.3 Pelosof, Lorraine C.; Gerber, David E. (2010). "Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment". Mayo Clinic Proceedings. 85 (9): 838–854. doi:10.4065/mcp.2010.0099. ISSN 0025-6196.
↑ Abdulaziz, Ammar Taha Abdullah; Yu, Xiao Qing; Zhang, Le; Jiang, Xin Yue; Zhou, Dong; Li, Jin Mei (2018). "Paraneoplastic cerebellar degeneration associated with cerebellar hypermetabolism". Medicine. 97 (24): e10717. doi:10.1097/MD.0000000000010717. ISSN 0025-7974.
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[Stewart2005-1] Stewart, Andrew F. (2005). "Hypercalcemia Associated with Cancer". New England Journal of Medicine. 352 (4): 373–379. doi:10.1056/NEJMcp042806. ISSN 0028-4793.

[Raftopoulos2007-2] Raftopoulos, Harry (2007). "Diagnosis and management of hyponatremia in cancer patients". Supportive Care in Cancer. 15 (12): 1341–1347. doi:10.1007/s00520-007-0309-9. ISSN 0941-4355.

[BarbosaRodien2005-3] Barbosa, Sandrine Laboureau-Soares; Rodien, Patrice; Leboulleux, Sophie; Niccoli-Sire, Patricia; Kraimps, Jean-Louis; Caron, Philippe; Archambeaud-Mouveroux, Françoise; Conte-Devolx, Bernard; Rohmer, Vincent (2005). "Ectopic Adrenocorticotropic Hormone-Syndrome in Medullary Carcinoma of the Thyroid: A Retrospective Analysis and Review of the Literature". Thyroid. 15 (6): 618–623. doi:10.1089/thy.2005.15.618. ISSN 1050-7256.

[FlorenzanoGafni2017-4] Florenzano, Pablo; Gafni, Rachel I.; Collins, Michael T. (2017). "Tumor-induced osteomalacia". Bone Reports. 7: 90–97. doi:10.1016/j.bonr.2017.09.002. ISSN 2352-1872.

[NauckReinecke2007-5] Nauck, Michael A.; Reinecke, Manfred; Perren, Aurel; Frystyk, Jan; Berishvili, Giorgi; Zwimpfer, Cornelia; Figge, Anja M.; Flyvbjerg, Allan; Lankisch, Paul G.; Blum, Werner F.; Klöppel, Günter; Schmiegel, Wolff; Zapf, Jürgen (2007). "Hypoglycemia due to Paraneoplastic Secretion of Insulin-Like Growth Factor-I in a Patient with Metastasizing Large-Cell Carcinoma of the Lung". The Journal of Clinical Endocrinology & Metabolism. 92 (5): 1600–1605. doi:10.1210/jc.2006-2573. ISSN 0021-972X.

[ThiersSahn2009-6] 6.0 ^6.1 Thiers, B. H.; Sahn, R. E.; Callen, J. P. (2009). "Cutaneous Manifestations of Internal Malignancy". CA: A Cancer Journal for Clinicians. 59 (2): 73–98. doi:10.3322/caac.20005. ISSN 0007-9235.

[GaduputiChandrala2014-7] Gaduputi, Vinaya; Chandrala, Chaitanya; Tariq, Hassan; Kanneganti, Kalyan (2014). "Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer". Case Reports in Oncological Medicine. 2014: 1–3. doi:10.1155/2014/825929. ISSN 2090-6706.

[TremblayMarcil2017-8] Tremblay, Catherine; Marcil, Isabelle (2017). "Necrolytic Migratory Erythema: A Forgotten Paraneoplastic Condition". Journal of Cutaneous Medicine and Surgery. 21 (6): 559–561. doi:10.1177/1203475417719051. ISSN 1203-4754.

[CohenKurzrock1987-9] Cohen, Philip R.; Kurzrock, Razelle (1987). "Sweet's syndrome and malignancy". The American Journal of Medicine. 82 (6): 1220–1226. doi:10.1016/0002-9343(87)90229-4. ISSN 0002-9343.

[YouJu2018-10] You, Hye Rin; Ju, Jae-Kyun; Yun, Sook Jung; Lee, Jee-Bum; Kim, Seong-Jin; Won, Young Ho; Lee, Seung-Chul (2018). "Paraneoplastic Pyoderma Gangrenosum Associated with Rectal Adenocarcinoma". Annals of Dermatology. 30 (1): 79. doi:10.5021/ad.2018.30.1.79. ISSN 1013-9087.

[PelosofGerber2010-11] 11.0 ^11.1 ^11.2 ^11.3 Pelosof, Lorraine C.; Gerber, David E. (2010). "Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment". Mayo Clinic Proceedings. 85 (9): 838–854. doi:10.4065/mcp.2010.0099. ISSN 0025-6196.

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@@ Line 2: / Line 2: @@
 '''For patient information, click [[Paraneoplastic syndrome (patient information)|here]]'''
 {{Paraneoplastic syndrome}}
+{{CMG}} ; {{AE}} {{G.D.}}<br>
+{{SK}} Paraneoplastic syndrome
+==Overview==
+'''Paraneoplastic syndromes''' are a rare type of [[diseases|disease]] that is caused by abnormal [[immune]] systems resulting from [[cancerous]] cells. Paraneoplastic syndromes are [[disorders]] due to the release of [[hormones]], or peptides that cause [[immune]] cross-reactivity between [[cancerous]] [[cells]] and normal [[tissues]]. Sometimes the [[symptoms]] of paraneoplastic syndromes show even before the [[diagnosis]] of a [[Malignant|malignancy]]. There is no [[screening]] for paraneoplastic syndromes. The stage and type of [[diagnosis]] of [[cancer]] determine the [[prognosis]] of a paraneoplastic syndrome. The [[causes]] are mostly related to the organ affected. The paraneoplastic syndromes are divided into four main categories such as [[musculocutaneous]], [[neurological]], [[hematological]] and [[Endocrine|endocrines]]. They are no cures for the paraneoplastic syndrome, but [[cancer]] treatment and some [[medications]] to reduce [[Autoimmunity|autoimmune]] responses are helpful.
+==Classification==
+* Paraneoplastic syndromes may be [[Classification|classified]] into 5 main categories accordingly:
+{| class="wikitable"
+|+
+|-
+| align="center" style="background:#4479BA; color: #FFFFFF;" |'''Type of paraneoplastic syndrome'''
+| align="center" style="background:#4479BA; color: #FFFFFF;" |'''Subtype'''
+| align="center" style="background:#4479BA; color: #FFFFFF;" |'''Associated Cancers'''
+|-
+| rowspan="5"  align="center" style="background:#f0f0f0;" |[[Endocrine]]
+|
+* [[Hypercalcemia]]<ref name="Stewart2005">{{cite journal|last1=Stewart|first1=Andrew F.|title=Hypercalcemia Associated with Cancer|journal=New England Journal of Medicine|volume=352|issue=4|year=2005|pages=373–379|issn=0028-4793|doi=10.1056/NEJMcp042806}}</ref>
+|
+* [[Breast cancer]] and [[lung cancer]] (typically [[Squamous cell carcinoma|squamous cell]]) due to the production of [[Parathyroid hormone-related protein|PTHrP]] ([[Parathyroid hormone]]-related [[protein]])[[multiple myeloma]], [[renal cell carcinoma]], [[ovarian cancer]], [[endometrial cancer]], and [[lymphoma]]
+*
+|-
+|
+* [[Syndrome of inappropriate antidiuretic hormone|SIADH]]<ref name="Raftopoulos2007">{{cite journal|last1=Raftopoulos|first1=Harry|title=Diagnosis and management of hyponatremia in cancer patients|journal=Supportive Care in Cancer|volume=15|issue=12|year=2007|pages=1341–1347|issn=0941-4355|doi=10.1007/s00520-007-0309-9}}</ref>
+|
+* [[Small cell lung cancer|Small-cell lung cancer]], [[mesothelioma]], [[breast]], [[prostate]], [[adrenal]], [[urethral]], [[thymoma]], [[lymphoma]], GI, CNS, and [[Ewing sarcoma]]
+*
+|-
+|
+* [[Ectopic]] [[ACTH]] [[secretion]]<ref name="BarbosaRodien2005">{{cite journal|last1=Barbosa|first1=Sandrine Laboureau-Soares|last2=Rodien|first2=Patrice|last3=Leboulleux|first3=Sophie|last4=Niccoli-Sire|first4=Patricia|last5=Kraimps|first5=Jean-Louis|last6=Caron|first6=Philippe|last7=Archambeaud-Mouveroux|first7=Françoise|last8=Conte-Devolx|first8=Bernard|last9=Rohmer|first9=Vincent|title=Ectopic Adrenocorticotropic Hormone-Syndrome in Medullary Carcinoma of the Thyroid: A Retrospective Analysis and Review of the Literature|journal=Thyroid|volume=15|issue=6|year=2005|pages=618–623|issn=1050-7256|doi=10.1089/thy.2005.15.618}}</ref>
+|
+* [[Small cell lung cancer|Small-cell lung cancer]], [[carcinoid tumor]], [[thymoma]], [[medullary carcinoma of the thyroid]] and other [[Cancer|cancers]]
+|-
+|
+* [[Tumor induced osteomalacia]]<ref name="FlorenzanoGafni2017">{{cite journal|last1=Florenzano|first1=Pablo|last2=Gafni|first2=Rachel I.|last3=Collins|first3=Michael T.|title=Tumor-induced osteomalacia|journal=Bone Reports|volume=7|year=2017|pages=90–97|issn=23521872|doi=10.1016/j.bonr.2017.09.002}}</ref>
+|
+* [[Metastatic]] [[breast cancer]]
+*
+|-
+|
+* [[Hypoglycemia]]<ref name="NauckReinecke2007">{{cite journal|last1=Nauck|first1=Michael A.|last2=Reinecke|first2=Manfred|last3=Perren|first3=Aurel|last4=Frystyk|first4=Jan|last5=Berishvili|first5=Giorgi|last6=Zwimpfer|first6=Cornelia|last7=Figge|first7=Anja M.|last8=Flyvbjerg|first8=Allan|last9=Lankisch|first9=Paul G.|last10=Blum|first10=Werner F.|last11=Klöppel|first11=Günter|last12=Schmiegel|first12=Wolff|last13=Zapf|first13=Jürgen|title=Hypoglycemia due to Paraneoplastic Secretion of Insulin-Like Growth Factor-I in a Patient with Metastasizing Large-Cell Carcinoma of the Lung|journal=The Journal of Clinical Endocrinology & Metabolism|volume=92|issue=5|year=2007|pages=1600–1605|issn=0021-972X|doi=10.1210/jc.2006-2573}}</ref>
+|
+* [[Gastrointestinal tract|GI]] cancers, [[mesothelioma]], [[lung]], [[real cancer]], and [[sarcomas]]
+|-
+| rowspan="6"  align="center" style="background:#f0f0f0;" |[[Mucocutaneous|Musculocutaneous]]
+|
+* [[Dermatomyositis]]<ref name="ThiersSahn2009">{{cite journal|last1=Thiers|first1=B. H.|last2=Sahn|first2=R. E.|last3=Callen|first3=J. P.|title=Cutaneous Manifestations of Internal Malignancy|journal=CA: A Cancer Journal for Clinicians|volume=59|issue=2|year=2009|pages=73–98|issn=0007-9235|doi=10.3322/caac.20005}}</ref>
+|
+* [[Breast cancer|Breast]], [[Ovarian cancer|ovarian]], [[Lung cancer|lung]], and [[prostate cancer]]
+*
+|-
+|
+* [[Leser-Trelat sign|Leser-Trélat sign]]<ref name="GaduputiChandrala2014">{{cite journal|last1=Gaduputi|first1=Vinaya|last2=Chandrala|first2=Chaitanya|last3=Tariq|first3=Hassan|last4=Kanneganti|first4=Kalyan|title=Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer|journal=Case Reports in Oncological Medicine|volume=2014|year=2014|pages=1–3|issn=2090-6706|doi=10.1155/2014/825929}}</ref>
+|
+* Gastrointestinal [[adenocarcinomas]] ([[Gastric adenocarcinoma|gastric]], [[Colon adenocarcinoma|colon]], rectal), [[breast cancer]], [[lymphoproliferative disorders]]/[[lymphoma]], and [[melanoma]].
+*
+|-
+|
+* [[Acanthosis nigricans]]<ref name="ThiersSahn2009">{{cite journal|last1=Thiers|first1=B. H.|last2=Sahn|first2=R. E.|last3=Callen|first3=J. P.|title=Cutaneous Manifestations of Internal Malignancy|journal=CA: A Cancer Journal for Clinicians|volume=59|issue=2|year=2009|pages=73–98|issn=0007-9235|doi=10.3322/caac.20005}}</ref>
+|
+* [[Gastric adenocarcinoma]], [[endometrial cancer]].
-{{CMG}} ; {{AE}} {{G.D.}}
+*
+|-
+|
+* [[Necrolytic migratory erythema]]<ref name="TremblayMarcil2017">{{cite journal|last1=Tremblay|first1=Catherine|last2=Marcil|first2=Isabelle|title=Necrolytic Migratory Erythema: A Forgotten Paraneoplastic Condition|journal=Journal of Cutaneous Medicine and Surgery|volume=21|issue=6|year=2017|pages=559–561|issn=1203-4754|doi=10.1177/1203475417719051}}</ref>
+|
+* [[Glucagonoma]]
-{{SK}} Paraneoplastic syndrome
+*
+|-
+|
+* [[Sweet's syndrome]]<ref name="CohenKurzrock1987">{{cite journal|last1=Cohen|first1=Philip R.|last2=Kurzrock|first2=Razelle|title=Sweet's syndrome and malignancy|journal=The American Journal of Medicine|volume=82|issue=6|year=1987|pages=1220–1226|issn=00029343|doi=10.1016/0002-9343(87)90229-4}}</ref>
+|
+* [[Acute myeloid leukemia|Acute myelogenous leukemia]], [[Myeloproliferative disease|myeloproliferative disorders]], [[lymphoproliferative disorders]], [[myelodysplastic syndrome]], and [[carcinoma]]
+*
+|-
+|
+* [[Pyoderma gangrenosum]]<ref name="YouJu2018">{{cite journal|last1=You|first1=Hye Rin|last2=Ju|first2=Jae-Kyun|last3=Yun|first3=Sook Jung|last4=Lee|first4=Jee-Bum|last5=Kim|first5=Seong-Jin|last6=Won|first6=Young Ho|last7=Lee|first7=Seung-Chul|title=Paraneoplastic Pyoderma Gangrenosum Associated with Rectal Adenocarcinoma|journal=Annals of Dermatology|volume=30|issue=1|year=2018|pages=79|issn=1013-9087|doi=10.5021/ad.2018.30.1.79}}</ref>
+|
+* [[Rectal Adenocarcinoma]], [[myeloproliferative disorders]], [[colon cancer]]
+*
+|-
+|+
+|-
+| rowspan="11"  align="center" style="background:#f0f0f0;" |[[Neurological]]<ref name="PelosofGerber2010">{{cite journal|last1=Pelosof|first1=Lorraine C.|last2=Gerber|first2=David E.|title=Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment|journal=Mayo Clinic Proceedings|volume=85|issue=9|year=2010|pages=838–854|issn=00256196|doi=10.4065/mcp.2010.0099}}</ref>
+|
+* [[Paraneoplastic cerebellar degeneration]]<ref name="AbdulazizYu2018">{{cite journal|last1=Abdulaziz|first1=Ammar Taha Abdullah|last2=Yu|first2=Xiao Qing|last3=Zhang|first3=Le|last4=Jiang|first4=Xin Yue|last5=Zhou|first5=Dong|last6=Li|first6=Jin Mei|title=Paraneoplastic cerebellar degeneration associated with cerebellar hypermetabolism|journal=Medicine|volume=97|issue=24|year=2018|pages=e10717|issn=0025-7974|doi=10.1097/MD.0000000000010717}}</ref>
+|
+* [[Breast cancer|Breast]] and [[gynecological malignancies]]
+*
+|-
+|
+* [[Encephalomyelitis]]<ref name="Graus2001">{{cite journal|last1=Graus|first1=F.|title=Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients|journal=Brain|volume=124|issue=6|year=2001|pages=1138–1148|issn=14602156|doi=10.1093/brain/124.6.1138}}</ref>
+|
+* [[Bronchial cancer]] (typically [[small cell lung carcinoma]])
+*
+|-
+|
+* [[Limbic encephalitis]]<ref name="ShenXu2018">{{cite journal|last1=Shen|first1=Kaini|last2=Xu|first2=Yan|last3=Guan|first3=Hongzhi|last4=Zhong|first4=Wei|last5=Chen|first5=Minjiang|last6=Zhao|first6=Jing|last7=Li|first7=Longyun|last8=Wang|first8=Mengzhao|title=Paraneoplastic limbic encephalitis associated with lung cancer|journal=Scientific Reports|volume=8|issue=1|year=2018|issn=2045-2322|doi=10.1038/s41598-018-25294-y}}</ref>
+|
+* [[Lung cancer]]
+*
+|-
+|
+* [[Encephalitis|Brainstem encephalitis]]<ref name="Blaes2013">{{cite journal|last1=Blaes|first1=Franz|title=Paraneoplastic Brain Stem Encephalitis|journal=Current Treatment Options in Neurology|volume=15|issue=2|year=2013|pages=201–209|issn=1092-8480|doi=10.1007/s11940-013-0221-1}}</ref><ref name="PelosofGerber2010">{{cite journal|last1=Pelosof|first1=Lorraine C.|last2=Gerber|first2=David E.|title=Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment|journal=Mayo Clinic Proceedings|volume=85|issue=9|year=2010|pages=838–854|issn=00256196|doi=10.4065/mcp.2010.0099}}</ref>
+|
+* [[Lung cancer]], [[testicular cancer]], [[neuroendocrine]] [[tumors]]
+*
+|-
+|
+* [[Opsoclonus]] (involving eye movement)<ref name="Blaes2013">{{cite journal|last1=Blaes|first1=Franz|title=Paraneoplastic Brain Stem Encephalitis|journal=Current Treatment Options in Neurology|volume=15|issue=2|year=2013|pages=201–209|issn=1092-8480|doi=10.1007/s11940-013-0221-1}}</ref>
+|
+* [[Neuroblastoma]], [[small cell lung cancer]] and [[gynecological]] [[tumors]]
+*
+|-
+|
+* [[Encephalitis]]
+|
+* [[Teratoma]]
+|-
+|
+* [[Polymyositis]]
+|
+* [[Squamous cell lung cancer]], [[breast cancer]]<ref name="GabrilovichRaza2006">{{cite journal|last1=Gabrilovich|first1=Mikhail|last2=Raza|first2=Mohammad|last3=Dolan|first3=Stephen|last4=Raza|first4=Tasleem|title=Paraneoplastic Polymyositis Associated With Squamous Cell Carcinoma of the Lung|journal=Chest|volume=129|issue=6|year=2006|pages=1721–1723|issn=00123692|doi=10.1378/chest.129.6.1721}}</ref>
+|-
+|
+* [[Autonomic neuropathy]]<ref name="urlParaneoplastic autonomic neuropathy: a case report | GM">{{cite web |url=https://www.gmjournal.co.uk/paraneoplastic-autonomic-neuropathy-a-case-report |title=Paraneoplastic autonomic neuropathy: a case report &#124; GM |format= |work= |accessdate=}}</ref>
+|
+* [[Carcinomas]],[[small cell lung cancer]], [[thymoma]]
+|-
+|
+* [[Lambert-Eaton myasthenic syndrome]] ([[LEMS]])
+|
+* [[Small cell lung cancer|Small-cell lung cancer]], [[prostate cancer]], [[lymphomas]], [[adenocarcinomas]]
+|-
+|
+* [[Myasthenia gravis]]
+|
+* [[Thymoma]]
+|-
+|
+* Subacute (peripheral) [[sensory neuropathy]]
+|
+* [[Small cell lung cancer]], [[breast cancer]], [[sarcomas]], [[Hodgkin lymphoma]], and [[ovarian cancer]]
+|-
+| rowspan="4"  align="center" style="background:#f0f0f0;" |[[Hematological]]<ref name="PelosofGerber2010">{{cite journal|last1=Pelosof|first1=Lorraine C.|last2=Gerber|first2=David E.|title=Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment|journal=Mayo Clinic Proceedings|volume=85|issue=9|year=2010|pages=838–854|issn=00256196|doi=10.4065/mcp.2010.0099}}</ref>
+|
+* [[Granulocytosis]]<ref name="AscensaoOken1987">{{cite journal|last1=Ascensao|first1=Joad L.|last2=Oken|first2=Martin M.|last3=Ewing|first3=Stephen L.|last4=Goldberg|first4=Robert J.|last5=Kaplan|first5=Manuel E.|title=Leukocytosis and large cell lung cancer. A frequent association|journal=Cancer|volume=60|issue=4|year=1987|pages=903–905|issn=0008-543X|doi=10.1002/1097-0142(19870815)60:4<903::AID-CNCR2820600431>3.0.CO;2-6}}</ref><ref name="AhnPark2005">{{cite journal|last1=Ahn|first1=Heui June|last2=Park|first2=Yeon Hee|last3=Chang|first3=Yoon Hwan|last4=Park|first4=Sun Hoo|last5=Kim|first5=Min-Suk|last6=Ryoo|first6=Baek Yeol|last7=Yang|first7=Sung Hyun|title=A Case of Uterine Cervical Cancer Presenting with Granulocytosis|journal=The Korean Journal of Internal Medicine|volume=20|issue=3|year=2005|pages=247|issn=1226-3303|doi=10.3904/kjim.2005.20.3.247}}</ref>
+|
+* [[Lung cancer]] (particularly [[large cell lung cancer]]), [[Gastrointestinal cancer|gastrointestinal]], [[Brain cancer|brain]], [[Breast cancer|breast]], [[Renal cancer|renal]], and [[gynecologic cancers]]
+|-
+|
+* [[Thrombocytosis]]<ref name="StoneNick2012">{{cite journal|last1=Stone|first1=Rebecca L.|last2=Nick|first2=Alpa M.|last3=McNeish|first3=Iain A.|last4=Balkwill|first4=Frances|last5=Han|first5=Hee Dong|last6=Bottsford-Miller|first6=Justin|last7=Rupaimoole|first7=Rajesha|last8=Armaiz-Pena|first8=Guillermo N.|last9=Pecot|first9=Chad V.|last10=Coward|first10=Jermaine|last11=Deavers|first11=Michael T.|last12=Vasquez|first12=Hernan G.|last13=Urbauer|first13=Diana|last14=Landen|first14=Charles N.|last15=Hu|first15=Wei|last16=Gershenson|first16=Hannah|last17=Matsuo|first17=Koji|last18=Shahzad|first18=Mian M.K.|last19=King|first19=Erin R.|last20=Tekedereli|first20=Ibrahim|last21=Ozpolat|first21=Bulent|last22=Ahn|first22=Edward H.|last23=Bond|first23=Virginia K.|last24=Wang|first24=Rui|last25=Drew|first25=Angela F.|last26=Gushiken|first26=Francisca|last27=Lamkin|first27=Donald|last28=Collins|first28=Katherine|last29=DeGeest|first29=Koen|last30=Lutgendorf|first30=Susan K.|last31=Chiu|first31=Wah|last32=Lopez-Berestein|first32=Gabriel|last33=Afshar-Kharghan|first33=Vahid|last34=Sood|first34=Anil K.|title=Paraneoplastic Thrombocytosis in Ovarian Cancer|journal=New England Journal of Medicine|volume=366|issue=7|year=2012|pages=610–618|issn=0028-4793|doi=10.1056/NEJMoa1110352}}</ref>
+|
+* [[Ovarian cancer]]
+|-
+|
+* [[Pure red cell aplasia]]<ref name="RosuCohen2011">{{cite journal|last1=Rosu|first1=Cristian|last2=Cohen|first2=Sandra|last3=Meunier|first3=Caroline|last4=Ouellette|first4=Denise|last5=Beauchamp|first5=Gilles|last6=Rakovich|first6=George|title=Pure red cell aplasia and associated thymoma|journal=Clinics and Practice|volume=1|issue=1|year=2011|pages=1|issn=2039-7283|doi=10.4081/cp.2011.e1}}</ref>
+|
+* [[Thymoma]], [[lymphoma]], [[leukemia]]
+|-
+|
+* [[Eosinophilia]]<ref name="PelosofGerber2010">{{cite journal|last1=Pelosof|first1=Lorraine C.|last2=Gerber|first2=David E.|title=Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment|journal=Mayo Clinic Proceedings|volume=85|issue=9|year=2010|pages=838–854|issn=00256196|doi=10.4065/mcp.2010.0099}}</ref>
+|
+* [[Lymphomas]], [[leukemias]], [[lung]], [[Gastrointestinal tumor|gastrointestinal]], and [[Genital cancer|gynecologic]] [[tumors]]
+|-
+| align="center" style="background:#f0f0f0;" |Others
+|
+* [[Membranous glomerulonephritis]]<ref name="LeeaphornKue-A-Pai2014">{{cite journal|last1=Leeaphorn|first1=Napat|last2=Kue-A-Pai|first2=Pogsathorn|last3=Thamcharoen|first3=Natanong|last4=Ungprasert|first4=Patompong|last5=Stokes|first5=Michael B.|last6=Knight|first6=Eric L.|title=Prevalence of Cancer in Membranous Nephropathy: A Systematic Review and Meta-Analysis of Observational Studies|journal=American Journal of Nephrology|volume=40|issue=1|year=2014|pages=29–35|issn=1421-9670|doi=10.1159/000364782}}</ref>
+|
+* [[Lung cancer]], [[prostate cancer]], and [[Hematologic malignancy|hematologic malignancies]]
+|-
+|}
+{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
+|+
-==Overview==
+|-
-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 (disease)|cancer]] cells. These phenomena are mediated by [[humoral]] factors (by [[Hormone|hormones]] or [[Cytokine|cytokines]]) excreted by [[tumor]] cells or by an [[immune response]] against the [[tumor]]. Sometimes the [[symptoms]] of paraneoplastic syndromes show even before the [[diagnosis]] of a [[Malignant|malignancy]]. The stage and type of the diagnosis of the [[cancer]] determine the [[prognosis]] of a paraneoplastic syndrome. The are no cures for paraneoplastic syndrome, but [[cancer]] treatment and some medications to reduce [[Autoimmunity|autoimmune]] responses are helpful.
-==Classification==
-Paraneoplastic syndromes may be classified into 4 main categories:
-*[[Mucocutaneous]] paraneoplastic syndromes <ref name="pmid9208889">{{cite journal |author=Cohen PR, Kurzrock R |title=Mucocutaneous paraneoplastic syndromes |journal=Semin. Oncol. |volume=24 |issue=3 |pages=334–59 |year=1997 |pmid=9208889 |doi=}}</ref>
-**[[Dermatomyositis]] (25-50% of adult patients have an underlying [[malignancy]])
-**[[Leser-Trelat sign|Leser-Trélat sign]], a sudden onset of many [[Pigmented lesions|pigmented]] [[skin]] lesions
-**[[Acanthosis nigricans]]
-**[[Necrolytic migratory erythema]]
-**[[Sweet's syndrome]]
-**[[Pyoderma gangrenosum]]
-*[[Neurological]] paraneoplastic syndromes: <ref>{{MeshName|Nervous+system+paraneoplastic+syndromes}}</ref><ref name="pmid19620862">{{cite journal |vauthors=Didelot A, Honnorat J |title=Update on paraneoplastic neurological syndromes |journal=Curr Opin Oncol |volume=21 |issue=6 |pages=566–72 |date=November 2009 |pmid=19620862 |doi=10.1097/CCO.0b013e3283306647 |url=}}</ref>
+|-
-**[[Paraneoplastic cerebellar degeneration]] associated with [[lung]], [[ovarian]], [[breast]], [[lymphatic]], and other cancers
-**[[Encephalomyelitis]] ([[inflammation]] of the [[brain]] and [[spinal cord]])
-**[[Limbic encephalitis]]
-**[[Encephalitis|Brainstem encephalitis]]
-**[[Opsoclonus]] (involving eye movement)
-**[[Encephalitis]] triggered by a [[teratoma]]<ref name="pmid17262855">{{cite journal |author=Dalmau J, Tüzün E, Wu HY, ''et al'' |title=Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma |journal=Ann. Neurol. |volume=61 |issue=1 |pages=25–36 |year=2007 |month=January |pmid=17262855 |pmc=2430743 |doi=10.1002/ana.21050 |url=}}</ref>
-**[[Polymyositis]]
-**[[Lambert-Eaton myasthenic syndrome]] ([[LEMS]]) in [[Small cell lung cancer|small-cell lung cancer]]
-**[[Myasthenia gravis]]
-**Subacute (peripheral) [[sensory neuropathy]]
-**[[Autonomic neuropathy]]
-*[[Hematological]] paraneoplastic syndromes <ref name="pmid9208888">{{cite journal |author=Staszewski H |title=Hematological paraneoplastic syndromes |journal=Semin. Oncol. |volume=24 |issue=3 |pages=329–33 |year=1997 |pmid=9208888 |doi=}}</ref><ref name="pmid8400277">{{cite journal |vauthors=Blay JY, Favrot M, Rossi JF, Wijdenes J |title=Role of interleukin-6 in paraneoplastic thrombocytosis |journal=Blood |volume=82 |issue=7 |pages=2261–2 |date=October 1993 |pmid=8400277 |doi= |url=}}</ref>
+|-
-**[[Granulocytosis]] (increased [[granulocyte]]s) due to the production of [[Granulocyte colony-stimulating factor|G-CSF]]
-**[[Eosinophilia]]
-**[[Pure red cell aplasia]]
-**[[Thrombocytosis]]
-*[[Endocrine|Endocrine metabolic]] [[Syndrome|syndromes]]:<ref>{{MeshName|Paraneoplastic+endocrine+syndromes}}</ref><ref name="pmid15673803">{{cite journal |vauthors=Stewart AF |title=Clinical practice. Hypercalcemia associated with cancer |journal=N. Engl. J. Med. |volume=352 |issue=4 |pages=373–9 |date=January 2005 |pmid=15673803 |doi=10.1056/NEJMcp042806 |url=}}</ref><ref name="pmid16337807">{{cite journal |vauthors=Spinazzé S, Schrijvers D |title=Metabolic emergencies |journal=Crit. Rev. Oncol. Hematol. |volume=58 |issue=1 |pages=79–89 |date=April 2006 |pmid=16337807 |doi=10.1016/j.critrevonc.2005.04.004 |url=}}</ref>
+|-
-**[[Hypercalcemia]] in [[breast cancer]] and [[lung cancer]] (typically squamous cell) due to the production of [[Parathyroid hormone-related protein|PTHrP]] ([[Parathyroid hormone]]-related [[protein]])
-***Seen in multiple [[myeloma]], [[renal cell carcinoma]], [[ovarian cancer]], [[endometrial cancer]], and [[lymphoma]]
-**[[Syndrome of inappropriate antidiuretic hormone|SIADH]]<ref name="pmid17701059">{{cite journal |vauthors=Raftopoulos H |title=Diagnosis and management of hyponatremia in cancer patients |journal=Support Care Cancer |volume=15 |issue=12 |pages=1341–7 |date=December 2007 |pmid=17701059 |doi=10.1007/s00520-007-0309-9 |url=}}</ref><ref name="pmid17507705">{{cite journal |vauthors=Ellison DH, Berl T |title=Clinical practice. The syndrome of inappropriate antidiuresis |journal=N. Engl. J. Med. |volume=356 |issue=20 |pages=2064–72 |date=May 2007 |pmid=17507705 |doi=10.1056/NEJMcp066837 |url=}}</ref>
-***Associated [[Cancer|cancers]]: [[small cell lung cancer]], [[mesothelioma]], [[breast]], [[prostate]], [[adrenal]], [[urethral]], [[thymoma]], [[lymphoma]], GI, CNS, and [[Ewing sarcoma]]
-**[[Ectopic]] [[ACTH]] [[secretion]] associated with [[Small cell lung cancer|small-cell lung cancer]], [[carcinoid tumor]], [[thymoma]] and other [[Cancer|cancers]]
-**[[Tumor induced osteomalacia]]
-**[[Hypoglycemia]]<ref name="pmid9876347">{{cite journal |vauthors=Teale JD, Marks V |title=Glucocorticoid therapy suppresses abnormal secretion of big IGF-II by non-islet cell tumours inducing hypoglycaemia (NICTH) |journal=Clin. Endocrinol. (Oxf) |volume=49 |issue=4 |pages=491–8 |date=October 1998 |pmid=9876347 |doi= |url=}}</ref>
-***Associated [[Cancer|cancers]]: [[Gastrointestinal tract|GI]], [[mesothelioma]], [[lung]], and [[sarcomas]]
-*Others that may not fit into any of the above categories include:
+|-
-**[[Membranous glomerulonephritis]]
-==Causes==
-===Common Causes===
-The major causes of paraneoplastic syndrome include:<ref name="pmid1591305">{{cite journal| author=Richardson GE, Johnson BE| title=Paraneoplastic syndromes in lung cancer. | journal=Curr Opin Oncol | year= 1992 | volume= 4 | issue= 2 | pages= 323-33 | pmid=1591305 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1591305  }}</ref><ref name="pmid8946620">{{cite journal| author=Gold PJ, Fefer A, Thompson JA| title=Paraneoplastic manifestations of renal cell carcinoma. | journal=Semin Urol Oncol | year= 1996 | volume= 14 | issue= 4 | pages= 216-22 | pmid=8946620 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8946620  }}</ref><ref name="pmid191296132">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }}</ref>
-*[[Small cell lung cancer]]
+|-
-*[[Non-small cell lung cancer]]
-*[[Myeloma]]
-*[[Breast cancer]]
-*[[Medullary thyroid cancer]]
-*[[Bronchial]] [[carcinoid]]
-*[[Pancoast tumor|Pancoast's tumour]]
-*[[Pancreatic cancer]]
-===Causes by Organ System===
+|-
-*Paraneoplastic syndromes causes may be regrouped by organ system.<ref name="pmid20810794">{{cite journal| author=Pelosof LC, Gerber DE| title=Paraneoplastic syndromes: an approach to diagnosis and treatment. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 9 | pages= 838-54 | pmid=20810794 | doi=10.4065/mcp.2010.0099 | pmc=2931619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20810794  }} </ref>
-{| style="width:82%; height:100px" border="1"
+|-
 |-
-|- bgcolor="LightSteelBlue"
+|-
-| '''[[List of skin diseases|Dermatologic]]'''
+|-
-| bgcolor="Beige" |[[Dermatomyositis]], [[Cutaneous T-cell lymphoma]]
+|}
+==Causes==
+===Common Causes===
+* The major [[causes]] of paraneoplastic syndrome include:<ref name="pmid1591305">{{cite journal| author=Richardson GE, Johnson BE| title=Paraneoplastic syndromes in lung cancer. | journal=Curr Opin Oncol | year= 1992 | volume= 4 | issue= 2 | pages= 323-33 | pmid=1591305 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1591305  }}</ref><ref name="pmid8946620">{{cite journal| author=Gold PJ, Fefer A, Thompson JA| title=Paraneoplastic manifestations of renal cell carcinoma. | journal=Semin Urol Oncol | year= 1996 | volume= 14 | issue= 4 | pages= 216-22 | pmid=8946620 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8946620  }}</ref><ref name="pmid191296132">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }}</ref>
+**[[Small cell lung cancer]]
+** [[Non-small cell lung cancer]]
+** [[Multiple myeloma]]
+** [[Breast cancer]]
+** [[Medullary thyroid cancer]]
+** [[Bronchial]] [[carcinoid]]
+** [[Pancoast tumor|Pancoast's tumour]]
+** [[Pancreatic cancer]]
+** [[Hepatocellular carcinoma]]
+** [[Gastric tumors]]
+** [[Gastrointestinal]] [[neuroendocrine tumors]] (NETS)
+** [[Leukemias]]
+** [[Lymphomas]]
+** [[Skin cancers]]
+** [[Renal carcinoma]]
+===Causes by Organ System===
+*Paraneoplastic syndromes [[causes]] may be regrouped by organ system.<ref name="pmid20810794">{{cite journal| author=Pelosof LC, Gerber DE| title=Paraneoplastic syndromes: an approach to diagnosis and treatment. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 9 | pages= 838-54 | pmid=20810794 | doi=10.4065/mcp.2010.0099 | pmc=2931619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20810794  }} </ref><ref name="pmid30876820">{{cite journal |vauthors=Henry K |title=Paraneoplastic syndromes: Definitions, classification, pathophysiology and principles of treatment |journal=Semin Diagn Pathol |volume=36 |issue=4 |pages=204–210 |date=July 2019 |pmid=30876820 |doi=10.1053/j.semdp.2019.01.002 |url=}}</ref>
+{| style="width:82%; height:100px" border="1"
+|-
+|- bgcolor="LightSteelBlue"
+| '''[[List of skin diseases|Dermatologic]]'''
+| bgcolor="Beige" |
+* [[Dermatomyositis]]
+* [[Cutaneous T-cell lymphoma]]
 |-
@@ Line 82: / Line 247: @@
 | '''[[ENT|Ear Nose Throat]]'''
-| bgcolor="Beige" |[[Oropharyngeal]] [[cancer]]
+| bgcolor="Beige" |
+* [[Oropharyngeal]] [[cancer]]
 |-
@@ Line 90: / Line 256: @@
 | '''[[Endocrine system|Endocrine]]'''
-| bgcolor="Beige" |[[Medullary thyroid cancer]], [[Adrenal cancer]]
+| bgcolor="Beige" |
+* [[Medullary thyroid cancer]]
+* [[Adrenal cancer]]
 |-
@@ Line 98: / Line 266: @@
 | '''[[Gastroenterology|Gastroenterologic]]'''
-| bgcolor="Beige" |[[Pancreatic cancer]],  Other [[Gastrointestinal tract|GI]] [[cancers]]
+| bgcolor="Beige" |
+* [[Pancreatic cancer]]
+* Other [[Gastrointestinal tract|GI]] [[cancers]]
 |-
@@ Line 106: / Line 276: @@
 | '''[[Hematology|Hematologic]]'''
-| bgcolor="Beige" |[[Myeloproliferative disorders]], [[Myeloma]], [[Melanoma]], [[Lymphoma]], [[Human T-lymphotropic virus|HTLV]]-associated [[Lymphoma]], [[Hodgkin's lymphoma]], [[Chronic lymphocytic leukemia]], [[Cancer|Cancers]] of the [[T-cells]] , [[Adult T-cell leukemia]], [[Acute myeloid leukemia]],
+| bgcolor="Beige" |
+* [[Myeloproliferative disorders]],
+*[[Multiple myeloma]], [[Melanoma]]
+* [[Lymphoma]]
+* [[Human T-lymphotropic virus|HTLV]]-associated [[Lymphoma]]
+* [[Hodgkin's lymphoma]]
+* [[Chronic lymphocytic leukemia]]
+* [[Cancer|Cancers]] of the [[T-cells]]
+* [[Adult T-cell leukemia]]
+* [[Acute myeloid leukemia]]
 |-
@@ Line 114: / Line 293: @@
 | '''[[Musculoskeletal system|Musculoskeletal]]/[[Orthopedics|Orthopedic]]'''
-| bgcolor="Beige" |[[Teratoma]], [[Sarcomas]], [[Ewing sarcoma ]]
+| bgcolor="Beige" |
+* [[Teratoma]]
+* [[Sarcomas]]
+* [[Ewing sarcoma]]
 |-
@@ Line 122: / Line 304: @@
 | '''[[Neurology|Neurologic]]'''
-| bgcolor="Beige" |[[Brain Cancer]]
+| bgcolor="Beige" |
+* [[Brain Cancer]]
 |-
@@ Line 130: / Line 313: @@
 | '''[[Obstetrics and Gynaecology|Obstetric/Gynecologic]]'''
-| bgcolor="Beige" |[[ovarian cancer]], [[Endometrial cancer]]
+| bgcolor="Beige" |
+* [[Ovarian cancer]]
+* [[Endometrial cancer]]
 |-
@@ Line 138: / Line 323: @@
 | '''[[Oncology|Oncologic]]'''
-| bgcolor="Beige" |[[Breast cancer]]
+| bgcolor="Beige" |
+* [[Breast cancer]]
 |-
@@ Line 146: / Line 332: @@
 | '''[[Lung|Pulmonary]]'''
-| bgcolor="Beige" |[[Small cell lung cancer]], [[Pancoast tumor|Pancoast's tumour]], [[Oat cell carcinoma]], [[Non-small cell lung cancer]], [[Malignant Mesothelioma]], [[Bronchiole|Bronchial]] [[carcinoid]]
+| bgcolor="Beige" |
+* [[Small cell lung cancer]]
+* [[Pancoast tumor|Pancoast's tumour]]
+* [[Oat cell carcinoma]]
+* [[Non-small cell lung cancer]]
+* [[Malignant Mesothelioma]]
+* [[Bronchiole|Bronchial]] [[carcinoid]]
 |-
@@ Line 154: / Line 346: @@
 | '''[[Renal]][[Electrolyte|/Electrolyte]]'''
-| bgcolor="Beige" |[[Kidney cancer]]
+| bgcolor="Beige" |
+* [[Kidney cancer|Renal cancer]]
 |-
@@ Line 162: / Line 355: @@
 | '''[[Rheumatology]][[Immunology|/Immunology]]/[[Allergy]]'''
-| bgcolor="Beige" | No underlying causes
+| bgcolor="Beige" |
+* No underlying causes
 |-
@@ Line 170: / Line 364: @@
 | '''[[Urology|Urologic]]'''
-| bgcolor="Beige" |[[Ureteral]] [[cancer]], [[Prostate cancer]], [[Bladder cancer]]
+| bgcolor="Beige" |
+* [[Ureteral]] [[cancer]]
+* [[Prostate cancer]]
+* [[Bladder cancer]]
 |-
@@ Line 178: / Line 377: @@
 | '''Miscellaneous'''
-| bgcolor="Beige" |[[Thymoma]], [[Testicular]] [[Germ Cell Tumor|germ-cell tumors]]
+| bgcolor="Beige" |
+* [[Thymoma]]
+* [[Testicular]] [[Germ Cell Tumor|germ-cell tumors]]
 |-
@@ Line 185: / Line 387: @@
 ==Differential diagnosis==
-Paraneoplastic syndromes must be differentiated from others types of cancer depending on the location and type of organs.
+Paraneoplastic syndromes must be [[Differentiate|differentiated]] from others types of [[cancer]] depending on the location and type of organs.
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 214: / Line 416: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Small cell lung cancer]]<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014]</ref><ref name="CarterGlisson2014">{{cite journal|last1=Carter|first1=Brett W.|last2=Glisson|first2=Bonnie S.|last3=Truong|first3=Mylene T.|last4=Erasmus|first4=Jeremy J.|title=Small Cell Lung Carcinoma: Staging, Imaging, and Treatment Considerations|journal=RadioGraphics|volume=34|issue=6|year=2014|pages=1707–1721|issn=0271-5333|doi=10.1148/rg.346140178}}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Small cell lung cancer]]<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014]</ref><ref name="CarterGlisson2014">{{cite journal|last1=Carter|first1=Brett W.|last2=Glisson|first2=Bonnie S.|last3=Truong|first3=Mylene T.|last4=Erasmus|first4=Jeremy J.|title=Small Cell Lung Carcinoma: Staging, Imaging, and Treatment Considerations|journal=RadioGraphics|volume=34|issue=6|year=2014|pages=1707–1721|issn=0271-5333|doi=10.1148/rg.346140178}}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |[[Cough]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Weakness]]
+* [[Cough]]
-| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]]
-[[Fatigue]]
+* [[Weakness]]
-| style="background: #F5F5F5; padding: 5px;" |[[Dyspnea]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[GI]] [[symptoms]]
+* [[Weight loss]]
-| style="background: #F5F5F5; padding: 5px;" |[[Lymphadenopathy]]
-[[Dehydration]]
+* [[Fatigue]]
-| style="background: #F5F5F5; padding: 5px;" |Decrease air entry in the [[lungs]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Digital clubbing]]
+* [[Dyspnea]]
-| style="background: #F5F5F5; padding: 5px;" |[[Bone|Bone tenderness]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[Calcium|Ca++]]
+* [[GI]] [[symptoms]]
-| style="background: #F5F5F5; padding: 5px;" |[[Hyponatremia]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* [[Lymphadenopathy]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chest|Chest Ct Scan]]: [[Necrotic]] and [[hemorrhagic]] [[hilar]] [[mass]], [[Lymphadenopathy]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Chest X-ray]]: [[Hilar|hilar mass]]
+* [[Digital clubbing]]
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Small, round and oval cells.
+* [[Bone|Bone tenderness]]
-[[Necrotic]]
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑ [[Calcium|Ca++]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Hyponatremia]]
+| style="background: #F5F5F5; padding: 5px;" | _
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Chest|Chest CT Scan]]: [[Necrotic]] and [[hemorrhagic]] [[hilar]] [[mass]] and [[lymphadenopathy]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Chest X-ray]]:
+* [[Hilar|Hilar mass]]
+| style="background: #F5F5F5; padding: 5px;" | _
+| style="background: #F5F5F5; padding: 5px;" |Small, round and oval cells
+[[Necrotic|Necrosis]]
 | style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |_
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Squamous cell carcinoma of the lung|Squamous lung cancer]]<ref name="Rosado-de-ChristensonTempleton1994">{{cite journal|last1=Rosado-de-Christenson|first1=M L|last2=Templeton|first2=P A|last3=Moran|first3=C A|title=Bronchogenic carcinoma: radiologic-pathologic correlation.|journal=RadioGraphics|volume=14|issue=2|year=1994|pages=429–446|issn=0271-5333|doi=10.1148/radiographics.14.2.8190965}}</ref>'''
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Asymptomatic]]  at first
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Chronic cough]]
+* [[Dyspnea]]
+* [[Weakness]]
 | style="background: #F5F5F5; padding: 5px;" |
-|-
+* [[Weight Loss|Weight]] [[Weight loss|loss]]
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Squamous cell carcinoma of the lung|Squamous lung cancer]]<ref name="Rosado-de-ChristensonTempleton1994">{{cite journal|last1=Rosado-de-Christenson|first1=M L|last2=Templeton|first2=P A|last3=Moran|first3=C A|title=Bronchogenic carcinoma: radiologic-pathologic correlation.|journal=RadioGraphics|volume=14|issue=2|year=1994|pages=429–446|issn=0271-5333|doi=10.1148/radiographics.14.2.8190965}}</ref>
+* [[Fatigue]]
-| style="background: #F5F5F5; padding: 5px;" |[[Asymptomatic]]  in early onset
+* [[Hemoptysis]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chronic cough|Chronic Cough]][[Dyspnea]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Weight Loss|Weight]] [[Weight loss|loss]][[Fatigue]], [[hemoptysis]]
+* [[Confusion]]
-| style="background: #F5F5F5; padding: 5px;" |[[Confusion|Confused]],
-[[Lymphadenopathy]]
-[[Fingers]] [[clubbing]]
+* [[Lymphadenopathy]]
-[[Weakness]]
+<br />
-| style="background: #F5F5F5; padding: 5px;" |Decreased [[breath sound]]
-| style="background: #F5F5F5; padding: 5px;" |-
-| style="background: #F5F5F5; padding: 5px;" |↑ [[Calcium|Ca++]]
-| style="background: #F5F5F5; padding: 5px;" |-
-| style="background: #F5F5F5; padding: 5px;" |-
-| style="background: #F5F5F5; padding: 5px;" |[[Chest|Chest Ct scan]] : [[Ground glass opacification on CT|Ground glass opacity]]
-| style="background: #F5F5F5; padding: 5px;" |[[Chest X-ray]]: Spiculated [[Mass]], [[Hilum of lung|bulky hilum]]
-| style="background: #F5F5F5; padding: 5px;" | -
-| style="background: #F5F5F5; padding: 5px;" |[[Intracellular]] bridges, central [[necrosis]] with [[cavitation]]
-| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Decreased [[breath sound]] in lung auscultation
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Fingers]] [[clubbing]]
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑ [[Calcium|Ca++]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Chest|Chest Ct scan]] : [[Ground glass opacification on CT|Ground glass opacity]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Chest X-ray]]: Spiculated [[Mass]], [[Hilum of lung|bulky hilum]]
+| style="background: #F5F5F5; padding: 5px;" | _
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Intracellular]] bridges
+* Central [[necrosis]] with [[cavitation]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |_
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hepatocellular carcinoma]]<ref name="ReynoldsFurlan2015">{{cite journal|last1=Reynolds|first1=Arich R.|last2=Furlan|first2=Alessandro|last3=Fetzer|first3=David T.|last4=Sasatomi|first4=Eizaburo|last5=Borhani|first5=Amir A.|last6=Heller|first6=Matthew T.|last7=Tublin|first7=Mitchell E.|title=Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know|journal=RadioGraphics|volume=35|issue=2|year=2015|pages=371–386|issn=0271-5333|doi=10.1148/rg.352140114}}</ref><ref name="FloresLang2011">{{cite journal|last1=Flores|first1=Yvonne N.|last2=Lang|first2=Cathy M.|last3=Salmerón|first3=Jorge|last4=Bastani|first4=Roshan|title=Risk Factors for Liver Disease and Associated Knowledge and Practices Among Mexican Adults in the US and Mexico|journal=Journal of Community Health|volume=37|issue=2|year=2011|pages=403–411|issn=0094-5145|doi=10.1007/s10900-011-9457-4}}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hepatocellular carcinoma]]<ref name="ReynoldsFurlan2015">{{cite journal|last1=Reynolds|first1=Arich R.|last2=Furlan|first2=Alessandro|last3=Fetzer|first3=David T.|last4=Sasatomi|first4=Eizaburo|last5=Borhani|first5=Amir A.|last6=Heller|first6=Matthew T.|last7=Tublin|first7=Mitchell E.|title=Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know|journal=RadioGraphics|volume=35|issue=2|year=2015|pages=371–386|issn=0271-5333|doi=10.1148/rg.352140114}}</ref><ref name="FloresLang2011">{{cite journal|last1=Flores|first1=Yvonne N.|last2=Lang|first2=Cathy M.|last3=Salmerón|first3=Jorge|last4=Bastani|first4=Roshan|title=Risk Factors for Liver Disease and Associated Knowledge and Practices Among Mexican Adults in the US and Mexico|journal=Journal of Community Health|volume=37|issue=2|year=2011|pages=403–411|issn=0094-5145|doi=10.1007/s10900-011-9457-4}}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |[[Asymptomatic]] in early onset.
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Fatigue]], [[Abdominal pain]][[Nausea]][[Vomiting]][[Fever]]
+* [[Asymptomatic]] at first
-| style="background: #F5F5F5; padding: 5px;" |[[Loss of appetite]][[Pruritus]] [[Jaundice]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Jaundice]]
+* [[Fatigue]]
-[[Cachexia]]
+* [[Abdominal pain]]
+* [[Nausea]]
-[[Ascites]]
+* [[Vomiting]]
-| style="background: #F5F5F5; padding: 5px;" |[[Splenomegaly]]
+* [[Fever]]
-| style="background: #F5F5F5; padding: 5px;" |-
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[PT|Prolong  PT]]
+* [[Loss of appetite]]
-| style="background: #F5F5F5; padding: 5px;" |↑  [[alpha fetoprotein]]
+* [[Pruritus]]
-| style="background: #F5F5F5; padding: 5px;" |-
+* [[Jaundice|yellow discoloration of skin]]
-| style="background: #F5F5F5; padding: 5px;" |-
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* [[Jaundice]]
+* [[Cachexia]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Splenomegaly]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Ascite|Abdominal swelling with fluid shift]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[PT|Prolonged  PT]]
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑  [[Alpha fetoprotein]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Ultrasonography|U/S]] : small hypoechoic
+* [[Ultrasonography|U/S]] : Small hypoechoic lesion
 * Irregular border with [[fibrosis]], and [[calcification]]
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Tumor cell|Polygonal tumor cells]]
+* [[Tumor cell|Polygonal tumor cells]]
 * Granular [[eosinophilic]] [[cytoplasm]]
-*
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
+* [[Biopsy]]
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |_
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !Diseases
@@ Line 302: / Line 543: @@
 !Additional findings
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Breast cancer]]<ref name="Mišković2016">{{cite journal|last1=Mišković|first1=Josip|title=DIAGNOSTIC VALUE OF FINE NEEDLE ASPIRATION CYTOLOGY FOR BREAST TUMORS|journal=ACTA CLINICA CROATICA|year=2016|pages=625–628|issn=03539466|doi=10.20471/acc.2016.55.04.13}}</ref><ref name="pmid29117654">{{cite journal| author=Mišković J, Zorić A, Radić Mišković H, Šoljić V| title=Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors | journal=Acta Clin Croat | year= 2016 | volume= 55 | issue= 4 | pages= 625-628 | pmid=29117654 | doi=10.20471/acc.2016.55.04.13 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29117654  }}</ref><ref name="pmid8004594">{{cite journal| author=McKenna RJ| title=The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis. | journal=Cancer | year= 1994 | volume= 74 | issue= 1 Suppl | pages= 244-55 | pmid=8004594 | doi=10.1002/cncr.2820741308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8004594  }}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Breast cancer]]<ref name="Mišković2016">{{cite journal|last1=Mišković|first1=Josip|title=DIAGNOSTIC VALUE OF FINE NEEDLE ASPIRATION CYTOLOGY FOR BREAST TUMORS|journal=ACTA CLINICA CROATICA|year=2016|pages=625–628|issn=03539466|doi=10.20471/acc.2016.55.04.13}}</ref><ref name="pmid29117654">{{cite journal| author=Mišković J, Zorić A, Radić Mišković H, Šoljić V| title=Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors | journal=Acta Clin Croat | year= 2016 | volume= 55 | issue= 4 | pages= 625-628 | pmid=29117654 | doi=10.20471/acc.2016.55.04.13 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29117654  }}</ref><ref name="pmid8004594">{{cite journal| author=McKenna RJ| title=The abnormal mammogram radiographic findings, diagnostic options, pathology, and stage of cancer diagnosis. | journal=Cancer | year= 1994 | volume= 74 | issue= 1 Suppl | pages= 244-55 | pmid=8004594 | doi=10.1002/cncr.2820741308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8004594  }}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |[[Lump]] in the [[breast]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Nipple discharge]]
+* [[Lump]] in the [[breast]]
-| style="background: #F5F5F5; padding: 5px;" |[[Bone pain]] [[Weight loss]]
+* [[Nipple discharge]]
-| style="background: #F5F5F5; padding: 5px;" |[[Loss of appetite]] [[Shortness of breath]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Enlarged [[Supraclavicular lymph nodes]]
+* [[Bone pain]]
-| style="background: #F5F5F5; padding: 5px;" |Dimpling of [[skin]] [[Nipples|Inverted nipples]]
+* [[Weight loss]]
-| style="background: #F5F5F5; padding: 5px;" |Bloody [[nipple discharge]], Change in [[Personality changes|personality]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |-
+* [[Loss of appetite]]
-| style="background: #F5F5F5; padding: 5px;" |-
+* [[Shortness of breath]]
-| style="background: #F5F5F5; padding: 5px;" |-
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Mammogram]]: [[Soft tissue|Soft]] [[tissue]] [[mass]]
+* Enlarged [[Supraclavicular lymph nodes]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Microcalcification]]
+* Dimpling of [[skin]] [[Nipples|Inverted nipples]]
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* Bloody [[nipple discharge]]
+*Change in [[Personality changes|personality]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Mammogram]]:
+** [[Soft tissue|Soft]] [[tissue]] [[mass]]
+** [[Microcalcification]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
 | style="background: #F5F5F5; padding: 5px;" |
 * Numerous [[mitotic]] figures
 *[[Pleomorphism]]
-| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |_
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal cell carcinoma|Renal cancer]]<ref name="CairnsSrivastava2011">{{cite journal|last1=Cairns|first1=Paul|last2=Srivastava|first2=Sudhir|last3=Grizzle|first3=William E.|title=Renal cell carcinoma|journal=Cancer Biomarkers|volume=9|issue=1-6|year=2011|pages=461–473|issn=18758592|doi=10.3233/CBM-2011-0176}}</ref><ref name="pmid7769125">{{cite journal| author=de la Mata J, Uy HL, Guise TA, Story B, Boyce BF, Mundy GR et al.| title=Interleukin-6 enhances hypercalcemia and bone resorption mediated by parathyroid hormone-related protein in vivo. | journal=J Clin Invest | year= 1995 | volume= 95 | issue= 6 | pages= 2846-52 | pmid=7769125 | doi=10.1172/JCI117990 | pmc=295971 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7769125  }}</ref><ref name="pmid3306861">{{cite journal| author=Laski ME, Vugrin D| title=Paraneoplastic syndromes in hypernephroma. | journal=Semin Nephrol | year= 1987 | volume= 7 | issue= 2 | pages= 123-30 | pmid=3306861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3306861  }}</ref><ref name="pmid20479778">{{cite journal| author=Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N| title=Imaging renal cell carcinoma with ultrasonography, CT and MRI. | journal=Nat Rev Urol | year= 2010 | volume= 7 | issue= 6 | pages= 311-25 | pmid=20479778 | doi=10.1038/nrurol.2010.63 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479778  }}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Renal cell carcinoma|Renal cancer]]<ref name="CairnsSrivastava2011">{{cite journal|last1=Cairns|first1=Paul|last2=Srivastava|first2=Sudhir|last3=Grizzle|first3=William E.|title=Renal cell carcinoma|journal=Cancer Biomarkers|volume=9|issue=1-6|year=2011|pages=461–473|issn=18758592|doi=10.3233/CBM-2011-0176}}</ref><ref name="pmid7769125">{{cite journal| author=de la Mata J, Uy HL, Guise TA, Story B, Boyce BF, Mundy GR et al.| title=Interleukin-6 enhances hypercalcemia and bone resorption mediated by parathyroid hormone-related protein in vivo. | journal=J Clin Invest | year= 1995 | volume= 95 | issue= 6 | pages= 2846-52 | pmid=7769125 | doi=10.1172/JCI117990 | pmc=295971 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7769125  }}</ref><ref name="pmid3306861">{{cite journal| author=Laski ME, Vugrin D| title=Paraneoplastic syndromes in hypernephroma. | journal=Semin Nephrol | year= 1987 | volume= 7 | issue= 2 | pages= 123-30 | pmid=3306861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3306861  }}</ref><ref name="pmid20479778">{{cite journal| author=Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N| title=Imaging renal cell carcinoma with ultrasonography, CT and MRI. | journal=Nat Rev Urol | year= 2010 | volume= 7 | issue= 6 | pages= 311-25 | pmid=20479778 | doi=10.1038/nrurol.2010.63 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479778  }}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |[[Hematuria]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Flank pain]]
+* [[Hematuria]]
-| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]]
+* [[Flank pain]]
-[[Anorexia]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal mass]] [[Fatigue]]
+* [[Weight loss]]
-| style="background: #F5F5F5; padding: 5px;" |[[Cachexia]]
+* [[Loss of appetite]]
-[[Abdominal bruit]] Palpable [[abdominal mass]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Supraclavicular lymph nodes|Supraclavicular lymphadenopathy]]
+* [[Abdominal mass]]
-| style="background: #F5F5F5; padding: 5px;" |[[High  blood pressure]]
+* [[Fatigue]]
-[[Pallor]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |↑ [[Calcium|ca++]] [[Polycythemia]] ↑ [[platelets]]
+* [[Cachexia]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[ALP]]
+* [[Abdominal bruit]]
-↑ [[LFT]]
+* Palpable [[abdominal mass]]
+| style="background: #F5F5F5; padding: 5px;" |
-↑ [[LDH]]
+* [[Supraclavicular lymph nodes|Supraclavicular lymphadenopathy]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[creatinine]] ↑ [[cancer cells]] in [[Urine|urine cytology]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] CT scan: Thickened irregular walls, [[Neoplastic|neoplastic mass]]
+* [[High  blood pressure]]
-| style="background: #F5F5F5; padding: 5px;" |-
+* [[Pallor]]
-| style="background: #F5F5F5; padding: 5px;" |-
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Depending on the subtypes.
+* ↑ [[Ca|Ca++]]
-| style="background: #F5F5F5; padding: 5px;" |[[Biopsy|Needle Biopsy]]
+* [[Polycythemia]]
+* ↑ [[Platelets]]
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑ [[ALP]]
+* ↑ [[LFT]]
+* ↑ [[LDH]]
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑ [[Creatinine]]
+* ↑ [[Cancer cells]] in [[Urine|urine cytology]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Abdominal]] CT scan:
+** Thickened irregular walls
+** [[Neoplastic|neoplastic mass]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
+* Depends on the subtypes
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Biopsy|Needle Biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |_
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pancreatic cancer]]<ref name="pmid19129613">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }}</ref><ref name="pmid15960930">{{cite journal| author=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A et al.| title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. | journal=Clin Transl Oncol | year= 2005 | volume= 7 | issue= 5 | pages= 189-97 | pmid=15960930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15960930  }}</ref><ref name="HollyChaliha2004">{{cite journal|last1=Holly|first1=Elizabeth A.|last2=Chaliha|first2=Indranushi|last3=Bracci|first3=Paige M.|last4=Gautam|first4=Manjushree|title=Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area|journal=Clinical Gastroenterology and Hepatology|volume=2|issue=6|year=2004|pages=510–517|issn=15423565|doi=10.1016/S1542-3565(04)00171-5}}</ref><ref name="pmid26495795">{{cite journal| author=Schmidt-Hansen M, Berendse S, Hamilton W| title=Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review. | journal=Pancreas | year= 2016 | volume= 45 | issue= 6 | pages= 814-8 | pmid=26495795 | doi=10.1097/MPA.0000000000000527 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26495795  }}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pancreatic cancer]]<ref name="pmid19129613">{{cite journal| author=Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS| title=Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy. | journal=JOP | year= 2009 | volume= 10 | issue= 1 | pages= 37-42 | pmid=19129613 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19129613  }}</ref><ref name="pmid15960930">{{cite journal| author=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A et al.| title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. | journal=Clin Transl Oncol | year= 2005 | volume= 7 | issue= 5 | pages= 189-97 | pmid=15960930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15960930  }}</ref><ref name="HollyChaliha2004">{{cite journal|last1=Holly|first1=Elizabeth A.|last2=Chaliha|first2=Indranushi|last3=Bracci|first3=Paige M.|last4=Gautam|first4=Manjushree|title=Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area|journal=Clinical Gastroenterology and Hepatology|volume=2|issue=6|year=2004|pages=510–517|issn=15423565|doi=10.1016/S1542-3565(04)00171-5}}</ref><ref name="pmid26495795">{{cite journal| author=Schmidt-Hansen M, Berendse S, Hamilton W| title=Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review. | journal=Pancreas | year= 2016 | volume= 45 | issue= 6 | pages= 814-8 | pmid=26495795 | doi=10.1097/MPA.0000000000000527 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26495795  }}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |Mid-[[epigastric]] [[pain]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Nausea]][[Jaundice]]
+* [[Epigastric]] [[pain]]
+* [[Nausea]]
-[[Dark urine]]
+* [[Jaundice|Yellow discoloration of skin]]
-| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]] [[Abdominal pain]]
+* [[Dark urine]]
-| style="background: #F5F5F5; padding: 5px;" |[[Anorexia]] [[Greasy stools]] [[Asthenia]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Cachexia]]
+* [[Weight loss]]
-Migratory superficial [[thrombophlebitis]] on the [[skin]]
+* [[Abdominal pain]]
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] distention and tenderness
+| style="background: #F5F5F5; padding: 5px;" |
-Left [[Supraclavicular]] [[lymphadenopathy]]
+* [[Loss of appetite]]
-| style="background: #F5F5F5; padding: 5px;" |[[Palpable|Palpable periumbilical]] [[mass]]
+* [[Greasy stools]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[bilirubin]]
+*[[Lack of energy]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[ALP]]
+| style="background: #F5F5F5; padding: 5px;" |
-↑ [[LFT]]
+* [[Cachexia]]
-| style="background: #F5F5F5; padding: 5px;" |[[Low albumin]] and [[cholesterol]]
+* Migratory superficial [[thrombophlebitis]] on the [[skin]]
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal|Abdominal Ct]] scan:
+| style="background: #F5F5F5; padding: 5px;" |
-[[Pancreatic duct|Pancreatic duct dilation]]
+* [[Abdominal]] distention and tenderness
+* Left [[Supraclavicular]] [[lymphadenopathy]]
-[[Pancreatic]] [[atrophy]] [[Obstruction]] of [[common bile duct]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* [[Palpable|Palpable periumbilical]] [[mass]]
-| style="background: #F5F5F5; padding: 5px;" |U/S: hypoechoic [[mass]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Nuclei|Small nuclei]]  [[Pleomorphic|Pleomorphism]]
+* ↑ [[Bilirubin]]
-[[Cytoplasm|Granular cytoplasm]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Spiral CT scan|Spiral CT scan with contrast]]
+* ↑ [[ALP]]
+* ↑ [[LFT]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Low albumin]] and [[cholesterol]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Abdominal|Abdominal CT]] scan:
+** [[Pancreatic duct|Pancreatic duct dilation]]
+** [[Pancreatic]] [[atrophy]]
+** [[Obstruction]] of [[common bile duct]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
+* U/S: hypoechoic [[mass]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Nuclei|Small nuclei]]
+* [[Pleomorphic|Pleomorphism]]
+* [[Cytoplasm|Granular cytoplasm]]
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Spiral CT scan|Spiral CT scan with contrast]]
+| style="background: #F5F5F5; padding: 5px;" |_
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastric cancer]]<ref name="pmid23667204">{{cite journal| author=Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P, Denlinger C et al.| title=Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 5 | pages= 531-46 | pmid=23667204 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23667204  }}</ref><ref name="pmid8239772">{{cite journal| author=Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R| title=Cancer of the stomach. A patient care study by the American College of Surgeons. | journal=Ann Surg | year= 1993 | volume= 218 | issue= 5 | pages= 583-92 | pmid=8239772 | doi=10.1097/00000658-199321850-00002 | pmc=1243028 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8239772  }}</ref><ref name="pmid3357941">{{cite journal| author=Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM et al.| title=Gastric adenocarcinoma: CT versus surgical staging. | journal=Radiology | year= 1988 | volume= 167 | issue= 2 | pages= 335-40 | pmid=3357941 | doi=10.1148/radiology.167.2.3357941 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3357941  }}</ref><ref name="pmid7859977">{{cite journal| author=Karita M, Tada M| title=Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy. | journal=Gastrointest Endosc | year= 1994 | volume= 40 | issue= 6 | pages= 749-53 | pmid=7859977 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7859977  }}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Gastric cancer]]<ref name="pmid23667204">{{cite journal| author=Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P, Denlinger C et al.| title=Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 5 | pages= 531-46 | pmid=23667204 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23667204  }}</ref><ref name="pmid8239772">{{cite journal| author=Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R| title=Cancer of the stomach. A patient care study by the American College of Surgeons. | journal=Ann Surg | year= 1993 | volume= 218 | issue= 5 | pages= 583-92 | pmid=8239772 | doi=10.1097/00000658-199321850-00002 | pmc=1243028 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8239772  }}</ref><ref name="pmid3357941">{{cite journal| author=Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM et al.| title=Gastric adenocarcinoma: CT versus surgical staging. | journal=Radiology | year= 1988 | volume= 167 | issue= 2 | pages= 335-40 | pmid=3357941 | doi=10.1148/radiology.167.2.3357941 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3357941  }}</ref><ref name="pmid7859977">{{cite journal| author=Karita M, Tada M| title=Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy. | journal=Gastrointest Endosc | year= 1994 | volume= 40 | issue= 6 | pages= 749-53 | pmid=7859977 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7859977  }}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |History of [[gastric ulcer]] Early [[satiety]] [[Hematemesis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* History of [[gastric ulcer]]
+* Early [[satiety]]
+* [[Hematemesis]]
 <br />
-| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Loss of appetite]]
+* [[Weight loss]]
-| style="background: #F5F5F5; padding: 5px;" |[[Dysphagia]]
-[[Abdominal discomfort]]
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal mass|Palpable abdominal mass]]
-| style="background: #F5F5F5; padding: 5px;" |Left [[supraclavicular]] [[lymphadenopathy]]
-| style="background: #F5F5F5; padding: 5px;" |-
-| style="background: #F5F5F5; padding: 5px;" |↑ [[CA 19-9]]
-[[Anemia]]<br />
-| style="background: #F5F5F5; padding: 5px;" |-
-| style="background: #F5F5F5; padding: 5px;" |-
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] [[CT scan]]:
-[[Gastric|Thickened gastric]] wall
-Loss of [[Rugal folds|rugal fold]]
+* [[Loss of appetite]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Difficulty swallowing]]
-[[Mucosal]] irregularity Ulcerative lesion
+* [[Abdominal discomfort]]
-| style="background: #F5F5F5; padding: 5px;" |-
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Endoscopy]]: [[Ulcer]]
+* [[Abdominal mass|Palpable abdominal mass]]
-| style="background: #F5F5F5; padding: 5px;" |Irregular [[tubular]] structure
+| style="background: #F5F5F5; padding: 5px;" |
-Minimal [[stroma]] and [[cellular]]
+* Left [[supraclavicular]] [[lymphadenopathy]]
+| style="background: #F5F5F5; padding: 5px;" |_
-[[Pleomorphism]]
+| style="background: #F5F5F5; padding: 5px;" |
+* ↑ [[CA 19-9]]
-[[Nucleus]] located at the periphery
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Endoscopy]] and [[biopsy]]
+* [[Anemia]]<br />
-| style="background: #F5F5F5; padding: 5px;" |[[Microangiopathic  hemolytic anemia]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
-Hypercogulable state
+* [[Abdominal]] [[CT scan]]:
+** [[Gastric|Thickened gastric]] wall
-[[Nephropathy|Menbranous nephropathy]]
+** Loss of [[Rugal folds|rugal fold]]
+** [[Mucosal]] irregularity Ulcerative lesion
-[[Polyarteritis nodosa]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
-[[Acanthosis nigricans]]
+* [[Endoscopy]]: [[Ulcer]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Irregular [[tubular]] structure
+* Minimal [[stroma]] and [[cellular]]
+* [[Pleomorphism]]
+* [[Nucleus]] located at the periphery
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Endoscopy]] and [[biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Microangiopathic  hemolytic anemia]]
+* Hypercogulable state
+* [[Nephropathy|Menbranous nephropathy]]
+* [[Polyarteritis nodosa]]
+* [[Acanthosis nigricans]]
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphoma]]<ref name="pmid15245605">{{cite journal| author=Hagler KT, Lynch JW| title=Paraneoplastic manifestations of lymphoma. | journal=Clin Lymphoma | year= 2004 | volume= 5 | issue= 1 | pages= 29-36 | pmid=15245605 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245605  }}</ref><ref name="pmid21339498">{{cite journal| author=Briani C, Vitaliani R, Grisold W, Honnorat J, Graus F, Antoine JC et al.| title=Spectrum of paraneoplastic disease associated with lymphoma. | journal=Neurology | year= 2011 | volume= 76 | issue= 8 | pages= 705-10 | pmid=21339498 | doi=10.1212/WNL.0b013e31820d62eb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21339498  }}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lymphoma]]]<ref name="pmid15245605">{{cite journal| author=Hagler KT, Lynch JW| title=Paraneoplastic manifestations of lymphoma. | journal=Clin Lymphoma | year= 2004 | volume= 5 | issue= 1 | pages= 29-36 | pmid=15245605 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245605  }}</ref><ref name="pmid21339498">{{cite journal| author=Briani C, Vitaliani R, Grisold W, Honnorat J, Graus F, Antoine JC et al.| title=Spectrum of paraneoplastic disease associated with lymphoma. | journal=Neurology | year= 2011 | volume= 76 | issue= 8 | pages= 705-10 | pmid=21339498 | doi=10.1212/WNL.0b013e31820d62eb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21339498  }}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |[[Weight loss]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Weight loss]]
-[[Abdominal pain]]
+* [[Abdominal pain]]
-| style="background: #F5F5F5; padding: 5px;" |[[Fever]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Fatigue]]
+* [[Fever]]
-| style="background: #F5F5F5; padding: 5px;" |[[Night sweat]]
+* [[Fatigue]]
-| style="background: #F5F5F5; padding: 5px;" |[[Lymphadenopathy]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Hepatosplenomegaly]]
+* [[Night sweat]]
-| style="background: #F5F5F5; padding: 5px;" |-
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* [[Lymphadenopathy]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[ESR]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Hepatosplenomegaly]]
-↑ [[LDH]]
+| style="background: #F5F5F5; padding: 5px;" |_
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* ↑ [[ESR]]
-| style="background: #F5F5F5; padding: 5px;" |[[Ct scan]] of [[abdomen]], [[pelvic]], and [[chest]]: for [[metastasis]] to distant [[organs]].
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* ↑ [[LDH]]
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |_
-| style="background: #F5F5F5; padding: 5px;" |It depends on the type of lymphoma
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]
+* [[CT scan]] of [[abdomen]], [[pelvic]], and [[chest]]: for [[metastasis]] to distant [[organs]]
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
+* Depends on the type of lymphoma
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |_
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovarian cancer]]<ref name="pmid22217630">{{cite journal| author=Hippisley-Cox J, Coupland C| title=Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm. | journal=BMJ | year= 2011 | volume= 344 | issue=  | pages= d8009 | pmid=22217630 | doi=10.1136/bmj.d8009 | pmc=3251328 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22217630  }}</ref><ref name="pmid22405464">{{cite journal| author=Li J, Fadare O, Xiang L, Kong B, Zheng W| title=Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis. | journal=J Hematol Oncol | year= 2012 | volume= 5 | issue=  | pages= 8 | pmid=22405464 | doi=10.1186/1756-8722-5-8 | pmc=3328281 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22405464  }}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Ovarian cancer]]<ref name="pmid22217630">{{cite journal| author=Hippisley-Cox J, Coupland C| title=Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm. | journal=BMJ | year= 2011 | volume= 344 | issue=  | pages= d8009 | pmid=22217630 | doi=10.1136/bmj.d8009 | pmc=3251328 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22217630  }}</ref><ref name="pmid22405464">{{cite journal| author=Li J, Fadare O, Xiang L, Kong B, Zheng W| title=Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis. | journal=J Hematol Oncol | year= 2012 | volume= 5 | issue=  | pages= 8 | pmid=22405464 | doi=10.1186/1756-8722-5-8 | pmc=3328281 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22405464  }}</ref>'''
-| style="background: #F5F5F5; padding: 5px;" |[[Asymptomatic]] in early onset Unexplained [[thromboses]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal pain]]
+* [[Asymptomatic]] at first
-Bloating distended
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Early satiety]]
+* [[Abdominal pain]]
-Increase of [[urinary]] [[frequency]] and [[urgency]]
+*[[Bloating]]
-| style="background: #F5F5F5; padding: 5px;" |Palpable [[adnexal]] [[mass]]
+| style="background: #F5F5F5; padding: 5px;" |
-[[Ascites]]
+* [[Early satiety]]
+* [[Urinary]] [[frequency]] and [[urgency]]
-[[Pleural effusion]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Legs [[swelling]] and [[tenderness]]
+* Palpable [[adnexal]] [[mass]]
-| style="background: #F5F5F5; padding: 5px;" |Diminish [[breath]] [[sound]] from the effusion
+*[[Ascites|Abdominal swelling with fluid shift]]
-| style="background: #F5F5F5; padding: 5px;" |↑ [[CA-125]]
+| style="background: #F5F5F5; padding: 5px;" |
-↑ [[Calcium|Ca++]]
+* Leg [[swelling]] and [[tenderness]]
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+* Diminished [[breath]] [[sound]] due to the effusion
-| style="background: #F5F5F5; padding: 5px;" |[[Pelvic]] U/S: [[Solid]] irregular [[mass]], irregular  thick [[septation]]
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Abdominal]] [[Ct scan]]: findings depend on the subtypes
+* ↑ [[CA-125]]
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Nuclear|Nuclear pleomorphism]] Macronucleolus Eccentric [[nucleus]] [[Psammoma body|Psammoma bodies]]
+* ↑ [[Calcium|Ca++]]
-[[Necrosis]]
+| style="background: #F5F5F5; padding: 5px;" |_
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Trousseau's syndrome|Trousseau]][[syndrome]]
+* [[Pelvic]] U/S: [[Solid]] irregular [[mass]] with irregular  thick [[septation]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Abdominal]] [[CT scan]]: findings depend on the subtypes
+| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Nuclear|Nuclear pleomorphism]]
+* Macronucleolus Eccentric [[nucleus]]
+* [[Psammoma body|Psammoma bodies]]
+* [[Necrosis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Biopsy]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Trousseau's syndrome|Trousseau]] [[syndrome]]
 |}
-==Prognosis==
-* There are no cures for paraneoplastic syndromes.<ref name="urlParaneoplastic Syndromes Information Page | National Institute of Neurological Disorders and Stroke">{{cite web |url=https://www.ninds.nih.gov/Disorders/All-Disorders/Paraneoplastic-Syndromes-Information-Page |title=Paraneoplastic Syndromes Information Page &#124; National Institute of Neurological Disorders and Stroke |format= |work= |accessdate=}}</ref>
-* The type and stage of the [[diagnosis]] of the [[cancer]] determine the [[prognosis]]<ref name="urlParaneoplastic Syndromes Information Page | National Institute of Neurological Disorders and Stroke">{{cite web |url=https://www.ninds.nih.gov/Disorders/All-Disorders/Paraneoplastic-Syndromes-Information-Page |title=Paraneoplastic Syndromes Information Page &#124; National Institute of Neurological Disorders and Stroke |format= |work= |accessdate=}}</ref>
-==Treatment==
-*[[Cancer]] is treated first, follow with [[Steroid|steroids]], [[immunoglobulin]] and [[irradiation]] to reduce the [[autoimmune]] response<ref name="urlParaneoplastic Syndromes Information Page | National Institute of Neurological Disorders and Stroke">{{cite web |url=https://www.ninds.nih.gov/Disorders/All-Disorders/Paraneoplastic-Syndromes-Information-Page |title=Paraneoplastic Syndromes Information Page &#124; National Institute of Neurological Disorders and Stroke |format= |work= |accessdate=}}</ref>
-*[[Plasmapheresis]].
-*[[Speech]] and [[physical therapy]] for some [[patients]].
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