Paraneoplastic syndrome is an impotant part of the differential diagnosis as we work through unexplained secondary findings in patients with cancer or suspected cancer. In simple terms, paraneoplastic syndrome involves secondary diseases or clinical findings caused by cancer through a systemic mechanism, usually a neuronal or endocrine mechanism where by either the tumor or the body's response to the tumor generates coumpounds that travel to another part of your body to create disease
While many different paraneoplastic syndromes exist, most commonly diseases such as SIADH of small cell lung cancer or hypercalcemia of squamous cell lung cancer, the ones that lead to an expensive battery of testing are generally those syndromes concerned with a suspected secondary neurological disease process. How do we screen for suspected paraneoplastic neurological disease?
It's called the paraneoplastic panel. This very expensive (I've heard some say it's over $10,000) panel of highly specialized labs are often ordered by neurologists in search for an answer to unexplained neurological presentations in a patient with cancer.
Classically, mental status changes in patients with cancer are caused by infections either systemic or local, metastasis of tumor to the brain, electrolyte abnormalities such as hyponatremia or hypercalcemia, central nervous system side effects of chemotherapy or whole brain radiation therapy, narcotic pain medication, hypercapnea, and uremia just to name a few of the many common causes of encephalopathy in cancer patients.
Once we hospitalists have worked through the most likely explanations for neurological changes, the neurologists will often take the work up to the next level with their pareneoplastic panel and an assortment of other labs I've never heard of.
It wasn't until recently that I learned our neurologists have been ordering the wrong panel all these years. Shame on them. Perhaps this is a sentinel event that requires an investigation from The Joint Commission.
And here I thought our neurologists were some of the smartest medical doctors to ever walk this earth. Was I wrong. It took this nursing documented telephone order, probably repeated back in triplicate according the Joint Commission mandated safety initiatives, to finally discover the how these patients are really supposed to be worked up. It's perineal plastic panel. Not paraneoplastic panel. How could we have been so wrong all these years?
The perineal plastic panel is really what our confused cancer patients have needed all these years. Not the paraneoplastic panel. You may laugh and think this picture is the funniest bar stool ever. It's not. It's the treatment of choice, the perineal plastic panel, our cancer patients have been missing all these years. Shame on you neurologists. You should have known what our patients really needed all these years.
For those of you that don't know, the perineum is the area between your genitals and your rectum. Hence this picture presentation of the perineal plastic panel.