Behaviour of Neoplasms Quiz

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Which of the following best defines a paraneoplastic syndrome?

A A systemic illness caused by opportunistic infection in immunocompromised cancer patients
B Local tissue destruction caused by direct invasion of adjacent structures by a tumour
C Systemic illness caused by widespread metastatic spread of a malignant tumour
D Physiological changes occurring as a result of chemotherapy or radiotherapy for a tumour
E A detectable systemic tumour effect not due to local invasion or metastasis ✓

The answer is E: A detectable systemic tumour effect not due to local invasion or metastasis

Explanation

Why E is correct

See Systemic Effects of Tumours. Option E is correct. A paraneoplastic syndrome is a group of signs and symptoms caused by a tumour at a distance from it, not by the tumour invading or spreading. Typical examples are ectopic hormone secretion (a hormone made by tumour cells in a tissue that does not normally make it) and effects driven by signalling proteins called cytokines. The effects can be endocrine, metabolic, neurological or general, and they may appear before the cancer itself is found, so recognising one can lead to an earlier cancer diagnosis. The key test is to ask whether the problem is explained by local invasion or by metastasis (spread to a distant site): if it is not, and it is not an infection or a treatment effect, think paraneoplastic. A memory aid: "para" means alongside, so the problem runs alongside the tumour rather than coming from its spread.

Definition: a paraneoplastic syndrome is caused by the tumour at a distance, not by invasion or metastasis.
Examples: ectopic hormone secretion and effects driven by cytokines.
Clue: it may appear before the cancer is found, so it can lead to an earlier diagnosis.

Why the other options are incorrect

A. A systemic illness caused by opportunistic infection in immunocompromised cancer patients: Opportunistic infection in an immunocompromised cancer patient is a complication of reduced immunity, not a paraneoplastic syndrome. It is a systemic illness, but it is caused by infection rather than by the tumour itself.
B. Local tissue destruction caused by direct invasion of adjacent structures by a tumour: Direct invasion of adjacent structures causes local tissue destruction and local symptoms from the tumour mass. A paraneoplastic syndrome is a distant systemic effect, so this definition describes local invasion rather than a paraneoplastic syndrome.
C. Systemic illness caused by widespread metastatic spread of a malignant tumour: Illness from widespread metastases comes from tumour deposits damaging the organs they grow in. A paraneoplastic syndrome is defined by effects that tumour spread does not explain.
D. Physiological changes occurring as a result of chemotherapy or radiotherapy for a tumour: Physiological changes after chemotherapy or radiotherapy are treatment-related side effects. They are not caused by the tumour itself, so they do not define a paraneoplastic syndrome.

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1
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2
Which statement best describes the main clinical use of tumour markers?

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