The paraneoplastic syndromes are a heterogenous group of disorders which complicate malignant disorders by affecting many different organ systems. They are often known as non-metastatic effects of malignancy. They have a variety of different aetiologies.

The clinical features of paraneoplastic syndromes are wide and varied. They may be classified as follows:

1. General-Cachexia, Weakness, Fever, Malaise

2. Musculoskeletal-Clubbing, Polymyalgia, Dermatomyositis, Myositis

3. Neurological-Sensory neuropathy, Motor neuropathy, Cerebellar Degeneration, Mononeuritis Multiplex, Dementia, Autonomic dysfunction

4. Dermatological-Dermatomyositis, Acanthosis nigricans, Reactive erythema, Papulosquamous disorders.

5. Hormonal-SIADH, Hypercalcaemia, Ectopic ACTH

6. Vascular-Thrombosis, DIC

7. Respiratory- Pleural effusion, Pleurisy, Pulmonary emboli

8. Renal- Nephrotic syndrome, Glomerulonephritis

9. Cardiovascular- Libbman-Sachs, Endocarditis, Hypotension.

There are no specific tests other than those to confirm conditions such as hormonal excess e.g. serum and urine osmolality for SIADH.

Probably the best clinical aids to diagnosis are to listen carefully to patient reports of new symptoms. Maintain a high index of suspicion.

In many ways the hardest diagnostic group are those with non-specific musculoskeletal paraneoplastic symptoms. Helpful clues might be signs of proximal weakness, together with abnormal blood parameters such as marked raised ESR, rouleau visible on blood film, thrombocytosis and a raised ferritin level.

When a paraneoplastic syndrome is suspected, supporting evidence should be sought.

One of the commonest biochemical problems encountered in palliative care is hypercalcaemia.

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