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Paraneoplastic Syndromes Treatment & Management

  • Author: Luigi Santacroce, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
Updated: Sep 30, 2015

Approach Considerations

Treatment varies with the type and location of the paraneoplastic disorder. Two general treatment options exist.

The first option is treatment of the underlying tumor. In general, the therapeutic protocols used are those that are applied to the disease in patients without paraneoplastic syndromes (ie, surgery, radiation, or chemotherapy, alone or in combination).

The second therapeutic option, in patients with clearly identifiable antibodies in their serum, is immunosuppression. This may be accomplished with intravenous immunoglobulins,[44, 45] steroids or other immunosuppressive drugs, or plasma exchange. Some patients with paraneoplastic pemphigus[46, 47, 48, 49] seem to derive some benefit from rituximab, but further studies are necessary to confirm this observation.

  • Standard perioperative care and monitoring before and after radiotherapy or chemotherapy are required.
  • Systematic psychotherapeutic and rehabilitative interventions may also be helpful.

Surgical Care

Surgical treatment for patients with paraneoplastic syndromes is typically directed toward the underlying neoplasm. On the other hand, some paraneoplastic disorders may resolve rapidly without surgery on the primary tumor (eg, in patients with hypertrophic osteoarthropathy, resection of either the tumor or the ipsilateral vagus nerve leads to rapid remission of symptoms).

Selected surgical options are as follows:

  • In patients with ectopic adrenocorticotropic hormone (ACTH) syndrome, bilateral adrenalectomy [50] with hormone replacement is the most effective treatment
  • Patients with thymoma must have complete surgical resection of the tumor to obtain complete remission of paraneoplastic syndromes (ie, myasthenia gravis)
Contributor Information and Disclosures

Luigi Santacroce, MD Assistant Professor, Medical School, State University at Bari, Italy

Disclosure: Nothing to disclose.


Lodovico Balducci, MD Professor, Oncology Fellowship Director, Department of Internal Medicine, Division of Adult Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida Morsani College of Medicine

Lodovico Balducci, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American College of Physicians, American Geriatrics Society, American Society of Hematology, New York Academy of Sciences, American Society of Clinical Oncology, Southern Society for Clinical Investigation, International Society for Experimental Hematology, American Federation for Clinical Research, American Society of Breast Disease

Disclosure: Nothing to disclose.

Laura Diomede University of Bari School of Medicine, Italy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Benjamin Movsas, MD 

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, American Society for Radiation Oncology

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Society of Hematology, Central Society for Clinical and Translational Research, American Society of Clinical Oncology

Disclosure: Nothing to disclose.


Silvia Gagliardi, MD Consulting Staff, Department of Surgery, Medical Center Vita, Italy

Disclosure: Nothing to disclose.

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