1. NEOPLASIA
Clinical Features of Tumors
&
Para-neoplastic syndromes
Dr. Roopam Jain
Professor & Head

2. NEOPLASIA
Clinical Features
of Tumors

3. The effects of a tumor on the host
A. LOCAL EFFECTS
 i) Compression - e.g. pituitary adenoma may lead to
serious endocrinopathy; a small benign tumour in ampulla of
Vater may lead to biliary obstruction.
 ii) Mechanical obstruction - Benign and malignant
tumours in the gut may produce intestinal obstruction.
 iii) Tissue destruction Malignant tumours, both
primary and metastatic, infiltrate and destroy the vital
structures.
 iv) Infarction, ulceration, haemorrhage -
infarction, surface ulceration, haemorrhage , torsion and
produce infarction and haemorrhage.

4. B. SYSTEMIC MANIFESTATIONS
 1. CANCER CACHEXIA
 2. FEVER
 3. TUMOUR LYSIS SYNDROME
 4. PARANEOPLASTIC SYNDROMES

5. 5
Clinical manifestations of Cancer
Cachexia – wasting
anorexia
early satiety
weight loss
anemia
marked weakness
taste alterations
altered metabolism

6. 1. Cancer Cachexia
 The causes of cachexia are obscure but cachexia is NOT caused
by the nutritional demands of the neoplasm
 results from the action of soluble factors such as cytokines
(TNF-alpha and IL-1) either produced by the tumor or the
host
 Various other causes of cancer cachexia include necrosis,
ulceration, haemorrhage, infection, malabsorption,
anxiety, pain, insomnia, hypermetabolism and pyrexia.

7. 2. FEVER
 Fever of unexplained origin
 Hodgkin’s disease, adenocarcinoma kidney,
osteogenic sarcoma
 The exact mechanism – Unknown (tumour cells
themselves elaborate pyrogens).

8. 3. TUMOUR LYSIS SYNDROME
 caused by extensive destruction of a large number of
rapidly proliferating tumour cells.
 lymphomas and leukaemias, chemotherapy,
administration of glucocorticoids or certain hormonal
agents (e.g. tamoxifen).
 It is characterized by hyperuricaemia, hyperkalaemia,
hyperphosphataemia and hypocalcaemia, all of which
may result in acidosis and renal failure.

9. Effects of Tumor on Host:
4. Paraneoplastic Syndromes
 group of conditions developing in patients with
advanced cancer,
 either by the local or distant spread of the tumor
or by the elaboration of hormones indigenous to
the tissue from which the tumor arose, are known
as PARANEOPLASTIC SYNDROMES
 About 10 to 15% of the patients with advanced
cancer develop one or more of the syndromes
included in the PNS

10. Paraneoplastic Syndromes
 Paraneoplastic syndromes are important for
three reasons:
 1) they may represent the earliest
manifestation of an occult tumor
 2) they may represent significant clinical
problems and may even be lethal
 3) they may mimic metastatic disease and
therefore confound treatment

11. Paraneoplastic Syndromes
(Endocrinopathies)
Cushing Syndrome Small cell
carcinoma-lung;
pancreatic
carcinoma; neural
tumors
ACTH or ACTH-
like substance
Syndrome of
inappropriate ADH
secretion
Small cell
carcinoma-lung;
intracranial
neoplasms
ADH or Atrial
natriuretic
hormones

12. Paraneoplastic Syndromes
(Endocrinopathies)
Hypercalcemia Lung (sq. cell),
breast, ovarian, renal
carcinoma; T-cell
leukemia/
lymphoma
PTH-related
peptide, TGF-alpha,
TNF-alpha, IL-1
Carcinoid Syndrome Bronchial adenoma;
pancreatic & gastric
carcinomas
Serotonin,
bradykinin, ?
Histamine

13. Paraneoplastic Syndromes
(Endocrinopathies)
Hypoglycemia Fibrosarcoma &
other sarcomas;
hepatocellular
carcinoma
Insulin or insulin-
like substances
Polycythemia Renal &
hepatocellular
carcinomas;
cerebellar
hemangioma
Erythropoietin

14. Paraneoplastic Syndromes
(Nerve and Muscle Syndromes)
Myasthenia Bronchogenic
carcinoma,
Thymoma
Immunologic
Disorders of the
central and
peripheral nervous
systems
Breast,
Carcinoma Lung
(small cell Ca),
Immunologic

15. Paraneoplastic Syndromes
(Dermatologic Syndromes)
Acanthosis nigricans Gastric, lung &
uterine carcinomas
?Immunologic, ?
Secretion of
epidermal growth
factor
Dermato-myositis Bronchogenic &
breast carcinomas
?Immunologic

16. Paraneoplastic Syndromes
(Dermatologic Syndromes)
Seborrheic
dermatitis
Bowel Immunologic

17. Paraneoplastic Syndromes
(Osseous, Articular, Soft Tissue Change)
Hypertrophic
osteoarthropathy and
clubbing of fingers
Bronchogenic
carcinoma
Unknown
Clubbing of fingers Bronchogenic
carcinoma
Unknown

18. Paraneoplastic Syndromes
(Vascular/Hematologic
Changes)
Venous thrombosis
(Trousseau
phenomenon)
Pancreatic &
Bronchogenic
carcinomas; other
neoplasms
Tumor products
(mucins that activate
clotting)
Non-bacterial
thrombotic
endocarditis
Many advanced
cancers
Hyper-coagulability

19. Paraneoplastic Syndromes
(RENAL SYNDROMES)
Nephrotic syndrome UNDERLYING
CANCER :
Various cancers &
Advanced cancers
MECHANISM:
Renal vein
thrombosis, systemic
amyloidosis

20. Paraneoplastic Syndromes
(HAEMATOLOGIC SYNDROMES)
Disseminated
intravascular
coagulation (DIC)
AML,
adenocarcinoma
Mechanism :
Chronic thrombotic
phenomena
Anaemia Thymoma Mechanism :
Unknown

21. Summary
The prognosis of a patient with any type of neoplasm
depends on a number of factors including:
 the rate of growth of the tumor,
 the size of the tumor,
 the tumor site,
 the cell type and
 degree of differentiation,
 the presence of metastasis,
 responsiveness to therapy,
 and the general health of the patient.