From the Guidelines
Yes, paraneoplastic syndrome can occur after a kidney tumor is removed. While removing the primary tumor often resolves paraneoplastic symptoms, in some cases these syndromes may persist or even develop after nephrectomy. This can happen due to several reasons: microscopic tumor cells might remain in the body despite the visible tumor being removed; metastases that weren't detected before surgery might be present; or the immune response triggered by the original tumor continues to cause symptoms even after tumor removal.
Common Paraneoplastic Syndromes
Common paraneoplastic syndromes associated with kidney cancer include:
- Hypercalcemia
- Erythrocytosis
- Hypertension
- Neuromuscular disorders Patients who have undergone kidney tumor removal should be monitored for persistent or new symptoms like unexplained weight loss, muscle weakness, fever, or neurological changes.
Treatment and Follow-up
Treatment focuses on managing the specific syndrome manifestations while searching for and addressing any residual cancer. Regular follow-up imaging and blood tests are essential to detect any recurrence or metastasis that might be causing ongoing paraneoplastic effects, as suggested by the European Association of Urology guidelines 1. The NCCN Guidelines for Kidney Cancer also provide multidisciplinary recommendations for the clinical management of patients with ccRCC and nonclear cell RCC (nccRCC) 1. According to the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of renal cell carcinoma, paraneoplastic syndromes such as hypercalcaemia, unexplained fever, erythrocytosis, and Stauffer’s syndrome can still be relatively frequent despite the classical triad of flank pain, gross haematuria, and palpable abdominal mass being less frequent than in the past 1.
From the Research
Paraneoplastic Syndrome After Kidney Tumor Removal
- Paraneoplastic syndromes (PNS) are rare clinical syndromes due to the systemic effects of tumors, unrelated to tumor size, invasiveness, or metastases 2.
- PNS can occur concurrently with tumor diagnosis, before tumor is diagnosed, and even after tumors have been resected 2.
- The removal of a kidney tumor may lead to the resolution of PNS in some patients, with one study showing that 52.1% of patients experienced resolution of PNS after nephrectomy 3.
- However, the presence of PNS before nephrectomy is associated with poorer survival in multivariable analysis, with a hazard ratio of 2.12 3.
Types of Paraneoplastic Syndromes
- Hypercalcemia, syndrome of inappropriate secretion of antidiuretic hormone, tumor lysis syndrome, renin-producing tumors, and paraneoplastic glomerulopathies are examples of PNS that can affect renal function 4.
- Other types of PNS include endocrine, neurological, musculocutaneous, hematological, and other syndromes 2.
- The incidence of PNS in patients with renal cell carcinoma (RCC) can vary, with one study reporting an incidence of 33.1% among 851 patients undergoing nephrectomy for suspected RCC 3.
Clinical Relevance of Paraneoplastic Syndromes
- PNS are estimated to occur in 10-15% of people with cancer and are the second direct cause of death (27% of cases) in cancer patients, after cancer itself 5.
- Early diagnosis and effective treatment of PNS may improve quality of life and alter prognosis of patients with RCC 4, 6.
- The use of electronic medical record (EMR) systems can provide a more robust method to capture data on PNS and their clinical relevance in patients with RCC 3.