Neuropathies Associated with

Malignancy

Kristine Faith Tablizo

Overview• local effects

• complications of therapy

• paraneoplastic effects

• tumor-derived immunoglobulins(in the case of B-cell tumors)

• local effects

• complications of therapy

• paraneoplastic effects

• tumor-derived immunoglobulins(in the case of B-cell tumors)

• Direct infiltration or compression of peripheral nerves Mononeuropathy*-commonbrachial plexopathy -apex of the lung

obturator palsy- pelvic cranial nerve palsies –intracranial

A polyradiculopathy of the lower extremity- meningeal carcinomatosis involving the cauda equina

• local effects

• complications of therapy

• paraneoplastic effects

• tumor-derived immunoglobulins(in the case of B-cell tumors)

• Nerve damage by:

• complications of chemotherapy

• Radiation

• poor nutrition

• Infection

• local effects

• complications of therapy

• paraneoplastic effects

• tumor-derived immunoglobulins(in the case of B-cell tumors)

• ‘collections of symptoms that result from substances produced by the tumor’

• can occur at any time during the patient’s course

• often precede dx

• Sensorimotor neuronopathy most common paraneoplastic form

**small cell lung cancer may also be seen: chronic inflammatory demyelinating polyradiculoneuropathy-like picture, plexopathy, and autonomic neuropathy

anti-Hu antibodies- recognize proteins expressed by cancer cells and normal neurons damage appears to be mediated by a CD8+ cytotoxic T-cell attack on dorsal root ganglion cells

usually start distally in an asymmetric and multifocal pattern

anti-CV2 autoantibodies -recognize CRMP5, an intracellular signaling protein, tend to present with a mixed axonal and demyelinating sensorimotor neuropathy

• local effects

• complications of therapy

• paraneoplastic effects

• tumor-derived immunoglobulins(in the case of B-cell tumors)

• Neuropathies associated with monoclonal gammopathies

• Paraproteins- monoclonal immunoglobulins or immunoglobulin fragments that damage nerves ; may be secreted by Neoplastic B cells

• IgM- secreting tumordemyelinating peripheral neuropathy pathogenic IgM paraprotein- thought to

bind directly to myelin-associated antigens such as myelin associated glycoprotein (MAG)

Deposition between myelin sheath membrane layers

• POEMS syndrome- rare paraneoplastic syndrome that is caused by an underlying plasma cell disorder Polyneuropathy Organomegaly Endocrinopathy Monoclonal gammopathy Skin changes development of demyelinating neuropathy

associated with deposition of paraproteins between noncompacted myelin lamellae

• excess immunoglobulin light chain amyloid deposit peripheral neuropathy due to vascular insufficiency or a direct toxic effects

Gammopathy- abnormal proliferation of the lymphoid cells producing immunoglobulins