Other Cancer-Related Complications
Cancer complications and paraneoplastic syndromes (acute oncology) – are very rare and may occur in any form of cancer – and may require urgent medical review.
Most UK hospitals have an Acute Oncology Service (AOS) – further information about these can be found here.
Paraneoplastic syndromes occur when a cancer causes unusual symptoms due to substances that circulate in the bloodstream. These substances may be hormones produced by the tumor or antibodies produced by the immune system. They can affect the function of various tissues and organs and cause symptoms at sites distant from the tumor. A rare group within these syndromes specifically target the body’s nervous system (for example Lambert-Eaton myasthenic syndrome – LEMS).]
About 1 in 5 people with cancer (of any form) may develop a paraneoplastic syndrome.
- Cushings Syndrome
- Syndrome of inappropriate ADH secretion (SIADH)
- Spinal cord compression
- Cauda equina syndrome
- Superior vena cava obstruction
- Lambert-Eaton myasthenic syndrome (LEMS)
Raised calcium levels – affects up to one third of cancer patients at some point in their disease course. There are two main causes of hypercalcaemia. The first is associated with the presence of bone metastasis and how these can affect calcium levels.
The second most common cause, also known as Humoral Hypercalcaemia of Malignancy (HHM), is related to the abnormal secretion of parathyroid-related hormone.
Both causes can be confirmed by measuring calcium levels in the blood.
Symptoms include nausea and vomiting, anorexia, thirst and polydipsia, polyuria, lethargy, bone pain, abdominal pain, constipation, confusion and weakness.
Raised cortisol levels – occurs when a hormone called ACTH is over-produced (hyper-secreted) by abnormal neuroendocrine cells. This causes the adrenal glands to make too much cortisol (a steroid hormone) and other hormones, causing symptoms of muscle weakness, weight loss, hypertension (high blood pressure), excessive hair growth, and osteoporosis, hypokalaemia (low potassium levels) and hyperglycaemia (raised blood sugars).
Occurs due to the excessive production of antidiuretic hormone (ADH), which causes an increase in hypervolemia leading to hyponatremia where plasma sodium levels are lowered and total body fluid is increased. Approximately 10% of patients who have Small Cell Lung Cancer exhibit SIADH with symptoms including confusion, seizure, reduced consciousness and coma.
The spinal cord is the bundle of nerves that carries messages back and forth from your brain to your muscles and other soft tissues. It is protected by a stack of backbones called vertebrae. The nerves of your spinal cord run through the openings between the vertebrae and out to your muscles. The most common causes of spinal cord compression is the gradual wear and tear on the bones of the spine : osteoarthritis. However spinal cord compression can develop more quickly, even very suddenly – due to trauma or the development of cancer in the spinal cord or the vertebrae. Symptoms can range from mild to severe:
They may be acute (sudden and severe) – and require urgent medical review – for example:
- Severe or increasing numbness between the legs, inner thighs, and back of the legs
- Severe pain and weakness that spreads into one or both legs, making it hard to walk or get out of a chair
- Loss of bowel or bladder control
- or chronic (occur over time and change in severity and frequency) – for example:
- Pain and stiffness in the neck, back, or lower back
- Burning / sharp pain that spreads to the arms, buttocks, or down into the legs (sciatica)
- Numbness, cramping, or weakness in the arms, hands, or legs
- Loss of sensation in the feet
- Trouble with hand or leg coordination
- “Foot drop,” weakness in a foot that causes a limp
- Loss of sexual ability – such as erection problems or loss of sensation
- “Saddle anesthesia” – imagine sitting on a saddle – saddle anaesthesia is the loss or reduced feeling/sensation in the parts of the body that touch the saddle i.e. the bits you sit on!
Is a rare but serious condition that describes extreme pressure and swelling of the nerves at the end of the spinal cord. These nerves control bowel and bladder functions as well as movement and sensation in the legs and feet. It can develop quickly with sudden severe symptoms, but may also develop slowly, with early symptoms that often mimic other conditions. The most common cause is a herniated (slipped) disc which puts pressure on these nerves. Other causes include trauma, infection, osteoporosis and cancer. Symptoms may be similar to those of spinal cord compression.
The superior vena cava (SVC) is a big vein in the middle of the chest, that carries blood from the upper body to the heart. SVCO occurs when either a cancer or lymph node mass grows too near the SVC, pressing against it or growing round it, causing a blockage or disruption of blood flow within it.
Is a very rare condition that may occur as a paraneoplastic disorder in association with cancer (CA-LEMS), notably small cell carcinoma of the lung. It affects the signals sent from the nerves to the muscles, which means that the muscles are unable to tighten (contract) properly, resulting in muscle weakness and a range of other symptoms.