Paraneoplastic Syndromes in Patients with Urological Malignancies

Abstract

Introduction: Paraneoplastic syndromes (PNS) may represent the main clinical problem in cancer patients; however, the knowledge of their clinical aspect remains quite poor among urologists. Objective: To provide urologists with an overview on main clinical aspects of PNS that have been reported to be associated to urological cancers. Methods: Literature search of peer-reviewed papers published by July 2008. Results: All genitourinary tumors can cause a PNS, and renal cell carcinoma is the most frequent urological malignancy involved. Prostate cancer is the second urological tumor associated with PNS which, conversely, are uncommon in bladder cancer and rare in testicular cancer. Tumor neuroendocrine differentiation is involved in most endocrine PNS. Neurologic PNS are very uncommon but may dominate the clinical picture and need a high suspicion index to be recognized. Important advances have been made on radionuclide scan methods in order to detect the primary tumor. The most effective treatment strategy is always represented by the radical therapy of the underlying cancer, but specific therapeutic options are sometimes available. Conclusions: Endocrine PNS are frequently associated with urological cancers, especially renal and prostate carcinoma. PNS have been rarely reported in association with cancers of bladder, urethra and testicle.

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“…The clinical picture of HM can be very polymorphic with some patients showing nonspecific symptoms such as asthenia, headache, lack of appetite, nausea, vomiting, constipation, somnolence, polyuria-polydipsia (due to nephrogenic diabetes insipidus), and others exhibiting a more severe and specific clinical presentation such as acute confusional or lethargic state or even coma associated with very high serum calcium (Ca ++ >12 mg/dl). When calcemia exceeds 18 mg/dl, shock and death occur [1]. The usual laboratory pattern is that of an elevated total and ionized calcium in the absence of other causes (bone metastases), low PTH values (PTH may be over the lowest value of the reference interval), and high levels of phosphates.…”

“…It has been attributed to tumor production of granulocyte colony-stimulating factor (G-CSF) which in turn promotes the development of mature neutrophils from hematopoietic progenitor cells [1]. The diagnostic evidence includes marked leukocytosis with predominant mature neutrophils, elevated serum G-CSF, positive immune histo chemical staining of tumor cells with anti-G-CSF antibody, leukocytosis and elevated serum G-CSF that reverses following tumor excision.…”

“…Constitutional symptoms are usually, but not exclusively, associated with the presence of RCC since it is estimated that 10-40% of patients with RCC will develop a PNS [1]. Most PNS associated with localized or at least surgically resectable RCC are definitively treated with nephrectomy.…”

“…Paraneoplastic polycythemia by cancerous overproduction of erythropoietin (EPO) is generally rare, but not in frequently seen in patients with renal cell carcinoma (RCC) where it involves 1-8% of patients [1]. Elevated red blood cell concentrations are thought to be mediated by erythropoietin (EPO), a glycoprotein produced by peritubular renal interstitial cells that promote red blood cell production in the bone marrow.…”

“…These symptoms are not related either to its local repercussion or distant spread and are not caused by infection, nutritional deficiency or treatment [1]. Recognition of a PNS is clinically important as it can lead to the diagnosis of a previously undetected neoplasm or more often can be used as a surrogate "tumor marker" of disease progression or remission as it follows the clinical course of the causative malignancy.…”