Can paraneoplastic syndrome cause urinary retention, sexual anhedonia, paresthesia (tingling and numbness) of the lower extremities, and fecal incontinence?

From the Guidelines

Yes, paraneoplastic syndrome can potentially cause urinary retention, sexual anhedonia, tingling and numbness in the lower extremities, and fecal incontinence. These symptoms can occur when certain cancers trigger an abnormal immune response that attacks the nervous system, particularly affecting the peripheral nerves, spinal cord, or autonomic nervous system. Paraneoplastic neurological syndromes like subacute sensory neuronopathy, autonomic neuropathy, or myelopathy can manifest with these symptoms, as seen in patients with small cell lung cancer, where neurologic syndromes include Lambert-Eaton myasthenic syndrome, encephalomyelitis, and sensory neuropathy 1. The underlying mechanism involves antibodies or immune cells mistakenly targeting neural tissues, causing inflammation and dysfunction.

Key Points to Consider

• Small cell lung cancer, gynecological cancers, breast cancer, and lymphomas are commonly associated with paraneoplastic syndromes 1.
• If experiencing these symptoms, prompt medical evaluation is essential as they may precede the diagnosis of cancer.
• Treatment typically involves addressing the underlying malignancy while managing neurological symptoms with immunosuppressive therapies such as corticosteroids, intravenous immunoglobulin, or plasma exchange.
• Early intervention is crucial as neurological damage may become irreversible if treatment is delayed, highlighting the importance of considering paraneoplastic syndromes in the differential diagnosis of patients presenting with neurological symptoms, as suggested by the NCCN guidelines for small cell lung cancer 1.

Clinical Implications

• The presence of paraneoplastic syndromes can significantly impact the quality of life and morbidity of patients, making early recognition and treatment critical.
• A comprehensive paraneoplastic antibody panel should be considered if a neurologic paraneoplastic syndrome is suspected, to guide diagnosis and treatment.
• The management of paraneoplastic syndromes requires a multidisciplinary approach, involving oncologists, neurologists, and other specialists, to ensure optimal care and outcomes for patients.

From the Research

Paraneoplastic Syndrome Symptoms

• Urine retention: There is no direct evidence in the provided studies to suggest that paraneoplastic syndrome can cause urine retention 2, 3, 4, 5, 6.
• Sexual anhedonia: The studies do not mention sexual anhedonia as a symptom of paraneoplastic syndrome 2, 3, 4, 5, 6.
• Tingling and numb lower extremities: Paraneoplastic neurological syndromes can affect the peripheral nervous system, which may lead to symptoms such as tingling and numbness in the lower extremities 3, 5, 6.
• Fecal incontinence: There is no direct evidence in the provided studies to suggest that paraneoplastic syndrome can cause fecal incontinence 2, 3, 4, 5, 6.

Paraneoplastic Neurological Syndromes

• These syndromes are immune-mediated disorders that occur in patients with cancer 2, 3, 4, 5, 6.
• They can affect the central and/or peripheral nervous system, leading to a variety of clinical presentations 2, 3, 5.
• The presence of specific antineuronal antibodies can facilitate the diagnosis and suggest treatment strategies 4, 5, 6.