eMedicine Specialties > Oncology > Special Topics in Oncology

Paraneoplastic Syndromes: Differential Diagnoses & Workup

Author: Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Coauthor(s): Laura Diomede, University of Bari School of Medicine, Italy; Silvia Gagliardi, MD, Consulting Staff, Department of Surgery, Medical Center Vita, Italy; Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute
Contributor Information and Disclosures

Updated: Mar 5, 2009

Differential Diagnoses

Abdominal Aortic Aneurysm
Nephrotic Syndrome
Anemia
Personality Disorders
Antithrombin Deficiency
Polycythemia Vera
Attention Deficit Hyperactivity Disorder
Polymyalgia Rheumatica
Bone Marrow Failure
Scleroderma
Chronic Fatigue Syndrome
Superficial Thrombophlebitis
Dermatomyositis
Systemic Lupus Erythematosus
Diabetes Mellitus, Type 1
Undifferentiated Connective-Tissue Disease
Glomerulonephritis, Acute
Mixed Connective-Tissue Disease
Myelodysplastic Syndrome

Other Problems to Be Considered

Antiglomerular basement membrane disease
Dementia
Encephalopathy
Encephalitis
Myelitis
Encephalomyelitis

Workup

Laboratory Studies

  • Patients with a suspected paraneoplastic disorder should receive a complete panel of laboratory studies of blood, urine, and cerebrospinal fluid (CSF).
  • CBC counts may demonstrate anemia. This anemia may be the result of any of several different types of cancer, or it may be the result of different benign conditions. The ESR is usually increased in patients with cancers and in those with infectious diseases. A microscopic study of the WBCs is helpful for diagnosis of leukemia or lymphoma-related disorders. Hypereosinophilia is frequently observed in patients with Hodgkin lymphoma. A platelet count must be performed in any patient with symptoms of DIC.
  • Blood enzymes may be altered, even in healthy individuals or those who have benign conditions. Increased plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), LDH, and alkaline phosphatase (ALP) are commonly observed in patients with malignancies of the digestive system as well as in patients with bone or muscle injuries. Protein electrophoresis of serum and CSF may demonstrate alterations of albumin levels and increased beta-globulins and gamma-globulins. Gamma-globulins are always increased in patients with autoimmune disorders, whether neoplastic or not. Oligoclonal bands are seen frequently on CSF electrophoresis.
  • Tumor markers are very useful for diagnosis of cancers that are clinically silent, but most markers are not specific for determining the origin of the cancer. For example, CEA (carcinoembryonic antigen) is increased in patients with tumors of the breast, lung, and digestive tract, as well as in patients who are heavy smokers. On the other hand, prostate-specific antigen (PSA) is increased only in patients with prostatic disorders, whether benign (including inflammatory diseases) or malignant. Examining the PSA free/total ratio will ensure a correct diagnosis.
  • Many patients with paraneoplastic disorders may have autoantibodies against several tissues of the body. Demonstration of these autoantibodies is very important to confirm the diagnosis of a paraneoplastic syndrome and distinguish it from nonneoplastic forms. Most known autoantibodies are directed against nervous system structures. Note that onco-neural antibodies' nomenclature is not internationally agreed, and to date 2 systems are being used: the first based on the first two letters of the surname of the patient, and the second based on tissue distribution of the antibody. Such antibodies are screened by indirect immunofluorescence.
    • Anti-Hu (previously called antineuronal nuclear antibody 1 or ANNA-1) is an autoantibody detected in the serum of patients with paraneoplastic subacute sensory neuronopathy and/or encephalomyelitis.
    • Anti-Ri (previously called antineuronal nuclear antibody 2 or ANNA-2) may be present in patients with opsoclonus/myoclonus syndrome.
    • Antibodies directed against amphiphysin (a synaptic vesicle protein) have been detected in the serum of patients with the paraneoplastic form of stiff man syndrome.31
    • The antineuronal antibodies Ma1 and Ma2 (also called anti-Ta) are members of a novel but expanding family of brain-specific or testis-specific proteins. While Ma1 is not found in association with one particular type of tumor, Ma2 seems to be associated strongly with testicular cancer.
    • The anti-Yo or anti-Purkinje cell antibody 1 (APCA-1) has been detected in patients with paraneoplastic cerebellar degeneration.

Imaging Studies

  • Any possible imaging study may be useful to detect the primary tumor in patients with paraneoplastic disorders.
  • CT scanning and magnetic resonance imaging of the whole body allow detection of the site and the extension of the underlying primary tumor and its metastases, if present.
  • Scintigraphy may be useful in patients with endocrine disorders related to a hormone-producing tumor.
  • Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) scanning may be performed to evaluate patients with neurologic disorders. These examinations allow differentiation of paraneoplastic and nonparaneoplastic neurologic disorders.

Procedures

Endoscopy is useful to detect tumors of the respiratory tree and of the digestive tract, and it also allows the examiner to obtain biopsy samples.

Histologic Findings

The histologic findings vary depending on the injured system. More details are included in Causes.

More on Paraneoplastic Syndromes

Overview: Paraneoplastic Syndromes
Differential Diagnoses & Workup: Paraneoplastic Syndromes
Treatment & Medication: Paraneoplastic Syndromes
Follow-up: Paraneoplastic Syndromes
References
[ CLOSE WINDOW ]

References

  1. Auche M. Des nevrites peripheriques chez les cancereux. Rev Med. 1890;10:785–807.

  2. Hobbs CB, Miller AL. Review of endocrine syndromes associated with tumours of non-endocrine origin. J Clin Pathol. Mar 1966;19(2):119-27. [Medline].

  3. Hashiba T, Saitoh Y, Asanuma N, et al. Reduction of a pancreatic tumor after total removal of an ACTH secreting pituitary tumor: differential diagnosis of Cushing's syndrome. Endocr J. Apr 2006;53(2):203-8. [Medline].

  4. Bataller L, Dalmau JO. Paraneoplastic disorders of the central nervous system: update on diagnostic criteria and treatment. Semin Neurol. Dec 2004;24(4):461-71. [Medline].

  5. Pittock SJ, Kryzer TJ, Lennon VA. Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol. Nov 2004;56(5):715-9. [Medline].

  6. Brain R, Norris FH eds. The remote effects of cancer on the nervous system. New York: Grune & Stratton; 1965.

  7. Kawasoe T, Yamamoto Y, Okumura Y, et al. A case report of paraneoplastic neurological syndrome associated with occult breast cancer. Breast Cancer. 2006;13(2):202-4. [Medline].

  8. Noorani A, Sadiq Z, Minakaran N, et al. Paraneoplastic cerebellar degeneration as a presentation of breast cancer - a case report and review of the literature. Int Semin Surg Oncol. Apr 21 2008;5:8. [Medline].

  9. Hagler KT, Lynch JW Jr. Paraneoplastic manifestations of lymphoma. Clin Lymphoma. Jun 2004;5(1):29-36. [Medline].

  10. Wiese W, Alansari H, Tranchida P, Madrid FF. Paraneoplastic polyarthritis in an ovarian teratoma. J Rheumatol. Sep 2004;31(9):1854-7. [Medline].

  11. Riedel RF, Burfeind WR Jr. Thymoma: benign appearance, malignant potential. Oncologist. Sep 2006;11(8):887-94. [Medline].

  12. Mygland A, Vincent A, Newsom-Davis J, et al. Autoantibodies in thymoma-associated myasthenia gravis with myositis or neuromyotonia. Arch Neurol. Apr 2000;57(4):527-31. [Medline].

  13. Gandhi L, Johnson BE. Paraneoplastic syndromes associated with small cell lung cancer. J Natl Compr Canc Netw. Jul 2006;4(6):631-8. [Medline].

  14. Ge F, Li ZJ, Cao ZL. Thymoma associated with severe diarrhoea and anaemia. Chin Med J (Engl). Mar 20 2006;119(6):526-8. [Medline].

  15. Batsis JA, Morgenthaler TI. Trousseau syndrome and the unknown cancer: use of positron emission tomographic imaging in a patient with a paraneoplastic syndrome. Mayo Clin Proc. Apr 2005;80(4):537-40. [Medline].

  16. Rashtak S, Pittelkow MR. Skin involvement in systemic autoimmune diseases. Curr Dir Autoimmun. 2008;10:344-58. [Medline].

  17. Rabhi M, Ennibi K, Harket A, et al. Acquired ichthyosis disclosing non-Hodgkin's malignant lymphoma. Intern Med. 2007;46(7):397-9. [Medline].

  18. Molina Garrido MJ, Guillen Ponce C, Macia Escalante S, et al. Cushing's paraneoplastic syndrome as first manifestation of an adenocarcinoma of unknown origin. Clin Transl Oncol. Aug 2006;8(8):621-3. [Medline].

  19. Meinardi JR, van den Berg G, Wolffenbuttel BH, et al. Cyclical Cushing's syndrome due to an atypical thymic carcinoid. Neth J Med. Jan 2006;64(1):23-7. [Medline].

  20. Takagi J, Otake K, Morishita M, et al. Multiple endocrine neoplasia type I and Cushing's syndrome due to an aggressive ACTH producing thymic carcinoid. Intern Med. 2006;45(2):81-6. [Medline].

  21. Fisher PG, Singer HS. Paraneoplastic opsoclonus. Neurology. Jul 1995;45(7):1421-2. [Medline].

  22. Anderson NE. Limbic encephalitis and anti-neuronal antibodies. Pathology. Apr 1989;21(2):152-3. [Medline].

  23. Benke T, Wagner M, Pallua AK, et al. Long-term cognitive and MRI findings in a patient with paraneoplastic limbic encephalitis. J Neurooncol. Jan 2003;66(1-2):217-24. [Medline].

  24. Ypma PF, Wijermans PW, Koppen H, et al. Paraneoplastic cerebellar degeneration preceding the diagnosis of Hodgkin's lymphoma. Neth J Med. Jul-Aug 2006;64(7):243-7. [Medline].

  25. Waterhouse DM, Natale RB, Cody RL. Breast cancer and paraneoplastic cerebellar degeneration. Cancer. Oct 15 1991;68(8):1835-41. [Medline].

  26. Marko PB, Miljkovic J, Zemljic TG. Necrolytic migratory erythema associated with hyperglucagonemia and neuroendocrine hepatic tumors. Acta Dermatovenerol Alp Panonica Adriat. Dec 2005;14(4):161-4, 166. [Medline].

  27. Fujita T, Fukuda K, Nishi H, et al. Paraneoplastic hypercalcemia with adenosquamous carcinoma of the colon. Int J Clin Oncol. Apr 2005;10(2):144-7. [Medline].

  28. Darnell RB. Paraneoplastic neurologic disorders: windows into neuronal function and tumor immunity. Arch Neurol. Jan 2004;61(1):30-2. [Medline].

  29. Scheinfeld NS. Ulcerative paraneoplastic dermatomyositis secondary to metastatic breast cancer. Skinmed. Mar-Apr 2006;5(2):94-6. [Medline].

  30. Rubenstein M, Duvic M. Cutaneous manifestations of Hodgkin's disease. Int J Dermatol. Mar 2006;45(3):251-6. [Medline].

  31. Iwata T, Inoue K, Mizuguchi S, et al. Thymectomy for paraneoplastic stiff-person syndrome associated with invasive thymoma. J Thorac Cardiovasc Surg. Jul 2006;132(1):196-7. [Medline].

  32. Buchwald B, Ahangari R, Weishaupt A, et al. Presynaptic effects of immunoglobulin G from patients with Lambert-Eaton myasthenic syndrome: their neutralization by intravenous immunoglobulins. Muscle Nerve. Apr 2005;31(4):487-94. [Medline].

  33. Koski CL, Patterson JV. Intravenous immunoglobulin use for neurologic diseases. J Infus Nurs. May-Jun 2006;29(3 Suppl):S21-8. [Medline].

  34. Barnadas M, Roe E, Brunet S, et al. Therapy of paraneoplastic pemphigus with Rituximab: a case report and review of literature. J Eur Acad Dermatol Venereol. Jan 2006;20(1):69-74. [Medline].

  35. Kaplan I, Hodak E, Ackerman L, et al. Neoplasms associated with paraneoplastic pemphigus: a review with emphasis on non-hematologic malignancy and oral mucosal manifestations. Oral Oncol. Jul 2004;40(6):553-62. [Medline].

  36. Lane JE, Woody C, Davis LS, et al. Paraneoplastic autoimmune multiorgan syndrome (paraneoplastic pemphigus) in a child: case report and review of the literature. Pediatrics. Oct 2004;114(4):e513-6. [Medline]. [Full Text].

  37. Wade MS, Black MM. Paraneoplastic pemphigus: a brief update. Australas J Dermatol. Feb 2005;46(1):1-8; quiz 9-10. [Medline].

  38. Li H, Yan W, Mao Q, et al. Role of adrenalectomy in ectopic ACTH syndrome. Endocr J. Dec 2005;52(6):721-6. [Medline].

  39. Akhyani M, Mansoori P, Taheri A, et al. Acrokeratosis paraneoplastica (Bazex syndrome) associated with breast cancer. Clin Exp Dermatol. Jul 2004;29(4):429-30. [Medline].

  40. Au WY, Hon C, Chan AC, et al. Vitiligo as a paraneoplastic syndrome preceding pituitary adenoma and subsequent acute lymphoblastic leukemia. Leuk Lymphoma. Aug 2004;45(8):1683-5. [Medline].

  41. Chamberlain AJ, Cooper SM, Allen J, et al. Paraneoplastic immunobullous disease with an epidermolysis bullosa acquisita phenotype: two cases demonstrating remission with treatment of gynaecological malignancy. Australas J Dermatol. May 2004;45(2):136-9. [Medline].

  42. de Beukelaar JW, Sillevis Smitt PA. Managing paraneoplastic neurological disorders. Oncologist. Mar 2006;11(3):292-305. [Medline].

  43. Derakhshani P, Klotz T, Heidenreich A, et al. Diffuse metastasized testicular teratoma and paraneoplastic thyreotoxicosis. Case report and literature review. Urol Int. 1999;63(4):265-7. [Medline].

  44. Dreessen J, Jeanjean AP, Sindic CJ. Paraneoplastic limbic encephalitis: diagnostic relevance of CSF analysis and total body PET scanning. Acta Neurol Belg. Jun 2004;104(2):57-63. [Medline].

  45. El Mahou S, Sailler L, Madaule S, et al. RACAND syndrome as a paraneoplastic syndrome?. J Clin Rheumatol. Apr 2006;12(2):104-5. [Medline].

  46. Enck RE. Paraneoplastic syndromes. Am J Hosp Palliat Care. Mar-Apr 2004;21(2):85-6. [Medline].

  47. Findling JW, Kehoe ME, Raff H. Identification of patients with Cushing's disease with negative pituitary adrenocorticotropin gradients during inferior petrosal sinus sampling: prolactin as an index of pituitary venous effluent. J Clin Endocrinol Metab. Dec 2004;89(12):6005-9. [Medline].

  48. Fong CS. Recent advance in immunological tests in paraneoplastic neurological syndrome. Acta Neurol Taiwan. Mar 2005;14(1):28-35. [Medline].

  49. French LE, Piletta PA, Etienne A, et al. Incidence of transient acantholytic dermatosis (Grover's disease) in a hospital setting. Dermatology. 1999;198(4):410-1. [Medline].

  50. Greenlee JE. Anti-Hu antibody and refractory nonconvulsive status epilepticus. J Neurol Sci. Jul 15 2006;246(1-2):1-3. [Medline].

  51. Hermitte L, Martin-Moutot N, Boucraut J, et al. Humoral immunity against glutamic acid decarboxylase and tyrosine phosphatase IA-2 in Lambert-Eaton myasthenic syndrome. J Clin Immunol. Jul 2000;20(4):287-93. [Medline].

  52. Honnorat J. Onconeural antibodies are essential to diagnose paraneoplastic neurological syndromes. Acta Neurol Scand Suppl. 2006;183:64-8. [Medline].

  53. Honnorat J, Antoine JC. Paraneoplastic neurological syndromes. Orphanet J Rare Dis. May 4 2007;2:22. [Medline].

  54. Honnorat J, Rogemond V, Antoine JC. [Mechanisms of paraneoplastic neurologic syndromes]. Rev Med Interne. Aug 1999;20(8):670-80. [Medline].

  55. Iranzo P, Lopez I, Robles MT, et al. Bullous pemphigoid associated with mantle cell lymphoma. Arch Dermatol. Dec 2004;140(12):1496-9. [Medline].

  56. Ishibashi H, Akamatsu H, Kojima K, et al. Good syndrome with thymic adenosquamous carcinoma--report of a case. Ann Thorac Cardiovasc Surg. Feb 2007;13(1):50-2. [Medline].

  57. Kanno K, Morokuma Y, Tateno T, et al. Olfactory neuroblastoma causing ectopic ACTH syndrome. Endocr J. Dec 2005;52(6):675-81. [Medline].

  58. Khachemoune A, Yalamanchili R, Rodriguez C. Bazex syndrome (paraneoplastic acrokeratosis). Cutis. Nov 2004;74(5):289-92. [Medline].

  59. Kurzydlo AM, Gillespie R. Paraneoplastic pityriasis rubra pilaris in association with bronchogenic carcinoma. Australas J Dermatol. May 2004;45(2):130-2. [Medline].

  60. Lecky BR. Transient neonatal Lambert-Eaton syndrome. J Neurol Neurosurg Psychiatry. Sep 2006;77(9):1094. [Medline].

  61. Lee DH, Lee SH, Sung JK. Inflammatory myofibroblastic tumor on intercostal nerve presenting as paraneoplastic pemphigus with fatal pulmonary involvement. J Korean Med Sci. Aug 2007;22(4):735-9. [Medline].

  62. Lee SH, Sung JK. Inflammatory pseudotumor of the spinal nerve complicated by paraneoplastic pemphigus. Case illustration. J Neurosurg Spine. Jun 2006;4(6):514. [Medline].

  63. Leidinger B, Bielack S, Koehler G, et al. High level of beta-hCG simulating pregnancy in recurrent osteosarcoma: case report and review of literature. J Cancer Res Clin Oncol. Jun 2004;130(6):357-61. [Medline].

  64. Lladó A, Carpentier AF, Honnorat J, et al. Hu-antibody-positive patients with or without cancer have similar clinicalprofiles. J Neurol Neurosurg Psychiatry. Aug 2006;77(8):996-7. [Medline].

  65. Martorell EA, Murray PM, Peterson JJ, et al. Palmar fasciitis and arthritis syndrome associated with metastatic ovarian carcinoma: a report of four cases. J Hand Surg [Am]. Jul 2004;29(4):654-60. [Medline].

  66. Mayer S, Cypess AM, Kocher ON, et al. Uncommon presentations of some common malignancies: Case 1. Sequential paraneoplastic endocrine syndromes in small-cell lung cancer. J Clin Oncol. Feb 20 2005;23(6):1312-4. [Medline].

  67. Menenakos C, Braumann C, Hartmann J, et al. Retroperitoneal Castleman's tumor and paraneoplastic pemphigus: report of a case and review of the literature. World J Surg Oncol. Apr 28 2007;5:45. [Medline].

  68. Morita H, Hirota T, Mune T, et al. Paraneoplastic neurologic syndrome and autoimmune Addison disease in a patient with thymoma. Am J Med Sci. Jan 2005;329(1):48-51. [Medline].

  69. Nieto JM, Pisegna JR. The role of proton pump inhibitors in the treatment of Zollinger-Ellison syndrome. Expert Opin Pharmacother. Feb 2006;7(2):169-75. [Medline].

  70. Noda M, Mori N, Nomura K, et al. Regression of idiopathic thrombocytopenic purpura after endoscopic mucosal resection of gastric mucosa associated lymphoid tissue lymphoma. Gut. Nov 2004;53(11):1698-700. [Medline].

  71. Norton JA, Jensen RT. Resolved and unresolved controversies in the surgical management of patients with Zollinger-Ellison syndrome. Ann Surg. Nov 2004;240(5):757-73. [Medline].

  72. Ono H, Yokozeki H, Katayama I, et al. Granuloma annulare in a patient with malignant lymphoma. Dermatology. 1997;195(1):46-7. [Medline].

  73. Perez NB, Bernad B, Narvaez J, et al. Erythema nodosum and lung cancer. Joint Bone Spine. May 2006;73(3):336-7. [Medline].

  74. Peter L, Jung J, Tilikete C, Ryvlin P, Mauguiere F. Opsoclonus-myoclonus as a manifestation of Lyme disease. J Neurol Neurosurg Psychiatry. Sep 2006;77(9):1090-1. [Medline].

  75. Pittock SJ, Lucchinetti CF. Inflammatory transverse myelitis: evolving concepts. Curr Opin Neurol. Aug 2006;19(4):362-8. [Medline].

  76. Posner JB. 10 Most Commonly Asked Questions About Paraneoplastic Syndromes. In: The Neurologist. 1998:[Full Text].

  77. Rosenzweig LB, Brett AS, Lefaivre JF, et al. Hidradenitis suppurativa complicated by squamous cell carcinoma and paraneoplastic neuropathy. Am J Med Sci. Mar 2005;329(3):150-2. [Medline].

  78. Shimoda T, Koizumi W, Tanabe S, et al. Small-cell carcinoma of the esophagus associated with a paraneoplastic neurological syndrome: a case report documenting a complete response. Jpn J Clin Oncol. Feb 2006;36(2):109-12. [Medline].

  79. Simpson DA, Pawlak AM, Tegmeyer L, Doig C, Cox D. Paraneoplastic intestinal pseudo-obstruction, mononeuritis multiplex, and sensoryneuropathy/neuronopathy. J Am Osteopath Assoc. 1996;96(2):125-8. [Medline].

  80. Sökmen M, Demirsoy H, Ersoy O, et al. Paraneoplastic porphyria cutanea tarda associated with cholangiocarcinoma: Casereport. Turk J Gastroenterol. 2007;18(3):200-205. [Medline].

  81. Tartaglia F, Blasi S, Sgueglia M, Polichetti P, Tromba L, Berni A. Retroperitoneal liposarcoma associated with small plaque parapsoriasis. World J Surg Oncol. Jul 2007;5:76. [Medline].

  82. Thomas L, Kwok Y, Edelman MJ. Management of paraneoplastic syndromes in lung cancer. Curr Treat Options Oncol. Feb 2004;5(1):51-62. [Medline].

  83. Torgerson EL, Khalili R, Dobkin BH, et al. Myasthenia gravis as a paraneoplastic syndrome associated with renal cell carcinoma. J Urol. Jul 1999;162(1):154. [Medline].

  84. Tsuchiya K, Minami I, Tateno T, et al. Malignant gastric carcinoid causing ectopic ACTH syndrome: discrepancy of plasma ACTH levels measured by different immunoradiometric assays. Endocr J. Dec 2005;52(6):743-50. [Medline].

  85. Waldum H. Assessment of the risk of iatrogenic hypergastrinaemia from patients with gastrinoma. Basic Clin Pharmacol Toxicol. Jan 2006;98(1):3. [Medline].

  86. Wilson J. Neuroimmunology of dancing eye syndrome in children. Dev Med Child Neurol. Aug 2006;48(8):693-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

paraneoplastic syndromes, paraneoplastic disorders,  dermatomyositis-polymyositis, Cushing syndrome, malignant carcinoid syndrome, stiff man syndrome, stiff person syndrome, opsoclonus/myoclonus syndrome, opsoclonus-myoclonus syndrome, Lambert-Eaton syndrome, Lambert-Eaton myasthenic syndrome, LEMS, myasthenia gravis, MG, paraneoplastic sensory   neuropathy, PSN, paraneoplastic limbic encephalitis, PLE, paraneoplastic cerebellar degeneration, PCD, paraneoplastic encephalomyelitis, PEM, fever, tumors, cancer

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Luigi Santacroce, MD, Assistant Professor, Medical School, State University at Bari, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Laura Diomede, University of Bari School of Medicine, Italy
Disclosure: Nothing to disclose.

Silvia Gagliardi, MD, Consulting Staff, Department of Surgery, Medical Center Vita, Italy
Disclosure: Nothing to disclose.

Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine; Division Chief, Senior Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute
Disclosure: Nothing to disclose.

Medical Editor

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri/Ellis Fischel Cancer Center
Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association
Disclosure: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.