| disease | Digestive System Cancer with Hematologic Syndrome |
Paraneoplastic syndrome refers to a group of symptoms similar to blood diseases, often accompanied by certain cancers of the digestive system, such as stomach cancer, intestinal cancer, pancreatic cancer, liver cancer, and gallbladder cancer. These symptoms are caused by the nature of the disease involving microvascular hemolysis, as well as the increase and decrease of blood cell components.
bubble_chart Pathological Changes
1. Microvascular nature of disease: Hemolytic anemia is mainly caused by tumor tissue components entering the blood circulation, activating the extrinsic coagulation system, leading to microvascular thrombosis or emboli, obstructing the passage of red blood cells in the circulation, which are then squeezed and ruptured, causing hemolysis. Peripheral blood smear microscopy reveals red blood cell fragments and specially deformed red blood cells, such as helmet-shaped, star-shaped, crescent-shaped, etc. It is also believed to be related to membrane proliferation in pulmonary microvessels and the formation of microvascular tumor emboli. Due to the massive consumption of platelets involved in coagulation, thrombocytopenia occurs.
2. Polycythemia: May be related to the excessive production of erythropoietin by cancer.
3. Leukemoid reaction: May be due to massive necrosis of tumor tissue or metastasis of cancer to the bone marrow, and may also be related to the production of granulocyte growth factors by tumor cells. Mostly granulocytic type, mainly manifested by an increase in the number of white blood cells in the peripheral blood, which can reach 5×109/L～10×109/L, with the appearance of immature white blood cells.
4. Eosinophilia: May be caused by an eosinophil chemotactic factor secreted by cancer cells.5. Lymphocytic leukemoid reaction: Increased white blood cell count in peripheral blood, with the majority in the blood smear being mature lymphocytes.
6. Erythroblastic anemia: Caused by cancer cells invading the bone marrow, destroying the barrier between the bone marrow and blood circulation. Nucleated red blood cells and many immature granulocytes can be seen in the peripheral blood.
7. Thrombocytosis: Increased platelet count, but generally not accompanied by thrombosis or bleeding.
8. Thrombotic thrombocytopenic purpura: May be caused by intravascular coagulation induced by tumors and consumptive reduction of platelets.
9. Intravascular coagulation, fibrinolysis.
bubble_chart Clinical Manifestations
1. Microvascular nature of disease: Hemolytic anemia is seen in stomach cancer, intestinal cancer, pancreatic cancer, and gallbladder cancer.
2. Polycythemia is seen in liver cancer, etc. Patients exhibit red-purple skin and mucous membranes, conjunctival congestion, increased blood viscosity, slow blood flow and congestion in various organs throughout the body, presenting symptoms such as headache, vertigo, fatigue, tinnitus, blurred vision, forgetfulness, numbness and stabbing pain in the extremities, and profuse sweating.
3. Leukemoid reaction can be caused by intestinal cancer, pancreatic cancer, stomach cancer, and liver cancer.
4. Eosinophilia can be caused by liver cancer, pancreatic cancer, intestinal cancer, and stomach cancer.
5. Lymphocytic leukemoid reaction is seen in stomach cancer, etc.
6. Erythroblastic anemia can be caused by gastrointestinal cancers.
7. Thrombocytosis occurs in disseminated gastrointestinal cancers.
8. Thrombotic thrombocytopenic purpura can be seen in stomach cancer.
9. Intravascular coagulation and fibrinolysis can be seen in pancreatic cancer, intestinal cancer, stomach cancer, and liver cancer. Clinically, it is mainly manifested by bleeding, with increased fibrin degradation products in the blood, resulting in a positive 3P test. {|108|}
Leukemoid reactions have the following characteristics: ① There is an underlying disease, and after treatment of the primary disease, the white blood cell count can return to normal; ② Generally, there is no significant anemia or thrombocytopenia; ③ Granulocytes show severe toxic changes, with toxic granules and vacuoles in the cytoplasm; ④ The activity of neutrophil alkaline phosphatase and glycogen are significantly increased; ⑤ There is no Ph' chromosome in the cells. When diagnosing eosinophilia, it is necessary to exclude eosinophilia caused by Chinese Taxillus Herb infestation and allergic reactions.
bubble_chart Treatment Measures
The primary approach involves treating the underlying disease and managing symptoms. The treatment of polycythemia focuses on addressing the primary cancer. If polycythemia causes significant symptoms, phlebotomy and the use of drugs such as Maitong, Weinaolutong, and Salvia may be employed.
1. Polycythemia needs to be differentiated from polycythemia vera.
2. Leukemoid reaction needs to be differentiated from leukemia.
3. Lymphocytic leukemoid reaction needs to be differentiated from those caused by viral infections and pestilential mononucleosis.
5. Thrombocytosis needs to be differentiated from thrombocytosis caused by other reasons.
