Thrombocytopenia, or low platelet count, is a common paraneoplastic syndrome seen in advanced pancreatic cancer patients. The cancer cells can disseminate to the bone marrow and interfere with platelet production. Additionally, cytokines released by pancreatic cancer as well as splenic vein occlusion related to a locally advanced tumor can both cause thrombocytopenia. Studies have shown lower preoperative platelet counts correlate with worse survival outcomes for pancreatic cancer patients specifically, compared to other tumor types. The pretreatment platelet count is an important prognostic indicator for pancreatic cancer.

1. PARANEOPLASTIC SYNDROMES
&
cancer paancreas
By
Hanan Zaghla
critical care medicine
Cairo University

2. PARANEOPLASTIC SYNDROMES- PNS
• Clinical syndromes due directly to systemic effects caused by tumours and unrelated to
their invasiveness or metastases
• PNS are important because non –recognition leads to missed, delayed or wrong diagnosis
• PNS have been recognized since the late ‘40s and are now estimated to occur in 8-15% of
cancer patients
•PNS can occur a) concurrently;
b) before tumour diagnosis or
c) even after tumour resected
• It is in the last two situations that it is particularly important to consider a PNS and to be
aware that many syndromes can be clinically similar to non-neoplastic diseases such as the
many diseases characterised by hypercalcaemia

3. PNS Continued
•The PNS associated tumours PNS fall mainly into 2 groups:
1 Endocrine and neuroendocrine tumours due to secretion of hormones, pro-hormone,
functionally active peptides
or
2 Tumours which operate mainly through immunological and autoimmune mechanisms
•Many organ systems are affected
•Examples of tumours causing PNS due to secretion hormones or functionally active peptides
are:
a. those where normal secretions by differentiated cells continue in a manner independent of
normal regulatory processes, eg. serotonin by carcinoid tumours
b. ectopic hormone secretions in which the hormone-producing cell’s machinery has been co-
opted to produce another hormone, eg.small cell carcinoma of the lung secreting ACTH

4. PNS continued
• PNS relating to to tumours operating through cytokines and immunoregulatory or auto
immune mechanisms result from the production of anti-tumour specific antibodies (Abs)
called onconeural antibodies
• Because of the shared tissue antigens (Ags) and the onconeural specific AgT-cells, tissue
components- as in the nervous system- are inadvertently attacked
• Remission of symptoms usually occures by removal of secretory tumours but
not always by resection of tumour causing PNS via immunologic mechanisms
• It is foreseen that many more PNS will emerge
• There has also been improved diagnosis and treatment

5. Take home message
Early recognition of a paraneoplastic syndrome by clinicians
is of paramount importance since it
will lead to earlier diagnosis of the tumour with improved
therapy and prognosis and avoid misdiagnoses

6. Is thrombocytopenia a common paraneoplastic syndrome?
Hematological paraneoplastic syndromes such as paraneoplastic thrombocytopenia and/or
immune thrombocytopenic purpura (ITP) are well described as secondary findings
simultaneously with malignanciesJanuary 2010European journal of clinical & medical
oncology 2(2)
Gustavo Pinto , PILAR HERRERA EHA Learning Center. PINTO SOLANO G. May 18,
2017; 182813 identified the patients by data search of hospital records from 2006 to
2016, with diagnosis of IT with previous diagnosis of cancer, not related with
chemotherapy or radiotherapy, not suggestive of bone marrow infiltration, drug-
induced, infection of disseminated intravascular coagulation. The CAIT is a rare
hematological paraneoplastic syndrome that occur in solid tumors, usually
associated to low platelet count but without life-threatening bleeding, requiring
therapy with corticosteroids as first line, and generally related with a benign
clinical course with a rapid and persistent response.: -)
uary 2010European journal of clinical & medical oncology 2(2
Hematological paraneoplastic syndromes such as paraneoplastic
thrombocytopenia and/or immune thrombocytopenic

7. - Studies have suggested that aggressive pancreatic
cancer cells may disseminate to the bone marrow, and
platelet counts may decrease in advanced pancreatic
cancer patients; additionally, locally advanced cancer
cases are usually accompanied by thrombocytopenia
caused by splenic vein occlusion ,also one of the
cytokines released in cancer pancreas is platelet factor 4 .

8. EBER
SI biopsies; no morphological evidence of coeliac disease
Relevant Abs and molecular profile tested - all were -ve
Diagnosis now was of some type of food intolerance
child put on selected diet. no response to dietery regime
Abdominal ultrasound reported as negative
Now 3 months of intractable diarrhoea
Child diagnosed as suffering from ‘todler’s diarrhoea’
Parents reassured and told ‘she would grow out of it’
UK consultant not satisfied as diarrhoea had still not been identified
as watery as apposed to osmotic; advised referral to specialist
Paediatric Unit:
SI biopsies reviewed.
Plasma cells considered to be increased in number

10. Our results indicate that the preoperative platelet count may have
different prognostic implications in pancreatic or periampullary
cancer compared with other tumours. We recommend a
pretreatment platelet count should be included in
clinicopathological indices analysed in clinical studies that involve
patients with ancreatic cancer.
p

11. EBER

12. Conclusion
This meta-analysis is the first to evaluate the platelet count
as a prognostic marker for patients with pancreatic cancer,
and the pooled results suggest that the pretreatment
platelet count is closely correlated with the prognosis of
patients with pancreatic cancer.