# Oncology Essentials for NEET PG Medicine: Paraneoplastic Syndromes, Oncologic Emergencies, Tumour Lysis, Tumour Markers, Lung Cancer Source: https://tracknation.in/story/oncology-essentials-for-neet-pg-medicine-paraneoplastic-syndromes-oncologic-emergencies-tumour-lysis-tumour-markers-lung-cancer (TrackNation — free UPSC notes with PYQs) > NEET PG Medicine: paraneoplastic syndromes and their tumours, spinal cord compression, hypercalcaemia, tumour lysis criteria and treatment, febrile neutropenia and G-CSF, antiemetics, tumour markers and their limits, lung cancer types and LDCT screening, carcinoid syndrome and NP-NCD cancer screening, with a diagram, hooks, vignette MCQs and cards. ## Start Here 🎯 **Exam priority: Medium.** *Expect: paraneoplastic syndrome–tumour pairs (ACTH and SCLC, PTHrP and squamous cancers, erythropoietin and renal cancer, Lambert–Eaton), cord compression, TLS laboratory criteria and treatment, neutropenia threshold and G-CSF, ondansetron, tumour markers and their misuse in screening, lung cancer subtypes and Pancoast/SVC features, LDCT screening, carcinoid syndrome, NP-NCD screening age.* CBME mapping: **GM 13.1–13.19**. Neoplasia biology and tumour pathology are in Pathology; anticancer drugs in Pharmacology; surgical oncology in Surgery; leukaemia/lymphoma in Pathology and article 20. *Paraneoplastic syndromes, emergencies, tumour lysis and markers. Drawn by TrackNation.* ## Paraneoplastic Syndromes - Symptoms at sites distant from the tumour or its metastases — from secreted substances or cross-reacting antibodies. - **Endocrine**: ectopic **ACTH** (Cushing features) — mostly small cell lung cancer; **PTHrP** (hypercalcaemia) — squamous lung, head-and-neck, bladder cancers; vasopressin (hyponatraemia) — lung cancers; **erythropoietin** (polycythaemia) — kidney cancer, hepatoma; IGF (hypoglycaemia). - **Neurological**: peripheral neuropathy (commonest), cerebellar syndromes, **Lambert–Eaton** (immune, myasthenia-like, limb weakness sparing eye and bulbar muscles). - **Skin and joints**: acanthosis nigricans (axillae, neck); hypertrophic osteoarthropathy with certain lung cancers. - **Carcinoid syndrome**: flushing, abdominal cramps, diarrhoea, later right-sided valve disease; urinary 5-HIAA; GI tumours cause it only after hepatic metastases; somatostatin analogues. ## Emergencies, Tumour Lysis and Chemotherapy Toxicity - **Spinal cord compression**: back pain, leg paraesthesias, bladder and bowel dysfunction — immediate surgery or radiotherapy. Most cancer deaths come from metastases. Drain symptomatic malignant effusions. - **Tumour lysis syndrome** (mainly leukaemias and lymphomas, also after CAR-T): AKI, Ca < 7, uric acid > 8, phosphate > 6.5, K⁺ > 6. Symptoms: lethargy, vomiting, seizures; arrhythmias from hyperkalaemia, tetany from hypocalcaemia. Treat with allopurinol 200–400 mg/m²/day (max 600 mg) and IV saline for urine > 2 L/day. - **Neutropenia**: ANC < 500/µL markedly increases infection risk; G-CSF shortens neutropenia; selected low-risk febrile neutropenia can be treated as outpatients. Antiemetics: ondansetron/granisetron. Mucositis is common. | **Marker (MSD)** | **Main use** | | AFP | Hepatocellular carcinoma, non-seminomatous germ cell tumours | | CEA | Colon cancer — follow-up of patients who had a raised level; not for screening | | CA 125 | Diagnosing and monitoring ovarian cancer (raised by peritoneal inflammation too) | | PSA | Prostate cancer (monitor recurrence) | | β-hCG | Gestational trophoblastic neoplasia | | Rule | Markers lack the sensitivity/specificity for early diagnosis or mass screening | ## Lung Cancer and Screening - **Lung cancer**: ~85% linked to smoking; **adenocarcinoma** is the commonest subtype, especially in never-smokers; diagnosis needs tissue (histology and molecular testing, e.g. EGFR). Presentations: cough, weight loss, haemoptysis, SVC syndrome, **Pancoast tumour** (shoulder/arm pain), hoarseness, brain metastases. Small cell lung cancer responds initially but relapses quickly. - Annual **low-dose CT** screening of high-risk adults cut lung cancer deaths by 20% vs chest X-ray (NLST). - **India (NP-NCD)**: population-based screening of everyone ≥ 30 years for hypertension, diabetes and oral, breast and cervical cancers. Cervical screening options include Pap and HPV testing. ## Traps the Examiner Sets - Tumour markers are for diagnosis support and monitoring, not mass screening. - Squamous lung cancer → hypercalcaemia (PTHrP); small cell → ACTH, SIADH. - Cord compression is an emergency — treat before paralysis. - TLS: high K, phosphate, urate; LOW calcium. - Carcinoid syndrome from gut tumours implies liver metastases. ## Memory Hooks & Shortcuts *Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.* - 🧠 **Small cell = 'Small hormones' (ACTH, ADH); Squamous = 'Stones' (calcium/PTHrP)** — lung paraneoplastic - 🧠 **TLS 'K-P-U up, Ca down'** — tumour lysis - 🧠 **Markers 'follow, don't fish' — monitor, not screen** — tumour markers - 🧠 **Carcinoid needs the liver bypassed (metastases)** — carcinoid - 🧠 **Cord compression: 'back pain in cancer = MRI today'** — cord compression ## Rapid-Revision Cards - Distant effects of tumour, not metastasis. - Small cell lung cancer. - Squamous lung, head-neck, bladder → hypercalcaemia. - Kidney cancer, hepatoma → polycythaemia. - Lung cancers. - Limb weakness, spares eyes/bulbar; presynaptic. - Peripheral neuropathy. - Lung cancer; painful joints. - Back pain, leg symptoms, sphincters → surgery/RT now. - Ca < 7, urate > 8, PO4 > 6.5, K > 6, AKI. - Allopurinol + IV saline (urine > 2 L/d). - ANC < 500. - Shortens neutropenia. - Ondansetron/granisetron. - HCC, non-seminoma. - Colon — monitor, not screen. - Ovary. - Trophoblastic disease. - ~85%. - Adenocarcinoma (never-smokers too). - Shoulder/arm pain. - 20% fewer deaths. - Flushing, diarrhoea; 5-HIAA; liver mets; octreotide. - ≥ 30 y: oral, breast, cervix, HTN, DM. ## Sources *Facts in this article were checked against these documents.* - MSD Manual Professional: Paraneoplastic Syndromes; Sequelae of Cancer; Management of Adverse Effects of Cancer Therapy; Tumor Immunodiagnosis; Lung Carcinoma; GI Neuroendocrine Tumors and Carcinoid Syndrome; Cancer Screening — Merck & Co. (MSD Manuals), reviewed 2024–26 (link) - National Programme for Prevention and Control of Non-Communicable Diseases — Operational Guidelines — Ministry of Health and Family Welfare, 2023 (link) - Competency Based Undergraduate Curriculum, General Medicine (GM 13) — National Medical Commission, 2024 ## Test Yourself: Practice Questions Thirty questions in NEET PG style, most of them clinical vignettes. ## Practice Questions (NEET PG pattern) *Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.* **Q1.** A paraneoplastic syndrome is defined as - (a) chemotherapy toxicity - (b) symptoms at sites distant from the tumour or its metastases - (c) metastatic spread - (d) direct tumour invasion **Answer: (b)** — Due to secreted substances or antibodies. **Q2.** A smoker with a lung mass develops Cushing features. The likely tumour is - (a) carcinoid of appendix - (b) squamous cell carcinoma - (c) adenocarcinoma of lung - (d) small cell lung cancer (ectopic ACTH) **Answer: (d)** — ACTH-like molecules. **Q3.** Hypercalcaemia from PTH-related peptide is typical of - (a) basal cell carcinoma - (b) small cell lung cancer only - (c) squamous cell lung, head-and-neck and bladder cancers - (d) seminoma **Answer: (c)** — Humoral hypercalcaemia of malignancy. **Q4.** Paraneoplastic polycythaemia from ectopic erythropoietin is associated especially with - (a) breast cancer - (b) prostate cancer - (c) kidney cancer and hepatoma - (d) melanoma **Answer: (c)** — Renal cell carcinoma. **Q5.** A patient with lung cancer has limb weakness that spares the eyes and bulbar muscles; the syndrome is immune-mediated and presynaptic. It is - (a) Lambert–Eaton syndrome - (b) myasthenia gravis - (c) polymyositis - (d) GBS **Answer: (a)** — Myasthenia-like. **Q6.** The most common neurological paraneoplastic syndrome is - (a) cerebellar degeneration - (b) limbic encephalitis - (c) peripheral neuropathy - (d) opsoclonus **Answer: (c)** — Cerebellar syndromes also occur. **Q7.** Painful swelling of knees, wrists and ankles in a patient with certain lung cancers suggests - (a) septic arthritis - (b) hypertrophic osteoarthropathy - (c) gout - (d) rheumatoid arthritis **Answer: (b)** — A paraneoplastic joint syndrome. **Q8.** Hyponatraemia in lung cancer can result from tumour production of - (a) renin - (b) vasopressin (ADH) - (c) insulin - (d) aldosterone **Answer: (b)** — Small cell and non-small cell lung cancers. **Q9.** A patient with known prostate cancer develops new back pain, leg paraesthesia and urinary retention. Management is - (a) analgesics and review in a month - (b) bed rest only - (c) physiotherapy - (d) immediate surgery or radiotherapy for spinal cord compression **Answer: (d)** — Treat before permanent paralysis. **Q10.** Most cancer deaths are due to - (a) chemotherapy - (b) metastases rather than the primary tumour - (c) the primary tumour only - (d) surgery **Answer: (b)** — Also inanition and organ failure. **Q11.** After the first chemotherapy cycle for lymphoma, a patient develops oliguria and seizures with high potassium, phosphate and uric acid and low calcium. The diagnosis is - (a) tumour lysis syndrome - (b) hypercalcaemia of malignancy - (c) septic shock - (d) SIADH **Answer: (a)** — Mainly leukaemias and lymphomas. **Q12.** Diagnostic laboratory criteria of tumour lysis syndrome include - (a) low potassium - (b) calcium < 7, uric acid > 8, phosphate > 6.5, potassium > 6 and AKI - (c) high calcium and low phosphate - (d) high sodium **Answer: (b)** — Calcium is LOW. **Q13.** Treatment of tumour lysis syndrome per MSD includes - (a) allopurinol 200–400 mg/m²/day with IV saline for urine output > 2 L/day - (b) fluid restriction - (c) thiazides - (d) calcium infusion first **Answer: (a)** — Close lab monitoring. **Q14.** Infection risk rises markedly in chemotherapy-induced neutropenia when the granulocyte count falls below - (a) 2000/µL - (b) 500/µL - (c) 5000/µL - (d) 1500/µL **Answer: (b)** — G-CSF shortens neutropenia. **Q15.** A drug used to shorten the duration of chemotherapy-induced neutropenia is - (a) erythropoietin - (b) G-CSF - (c) vitamin B12 - (d) interferon **Answer: (b)** — Or GM-CSF. **Q16.** Antiemetics with virtually no toxicity apart from headache, used for chemotherapy nausea, are - (a) haloperidol - (b) metoclopramide high dose - (c) ondansetron and granisetron - (d) promethazine **Answer: (c)** — 5-HT3 antagonists. **Q17.** A raised CEA is best used to - (a) monitor colon cancer after treatment, not to screen - (b) diagnose hepatitis - (c) diagnose lung cancer - (d) screen the population for colon cancer **Answer: (a)** — Markers lack specificity for screening. **Q18.** Alpha-fetoprotein is raised in - (a) hepatocellular carcinoma and non-seminomatous germ cell tumours - (b) colon cancer - (c) seminoma only - (d) prostate cancer **Answer: (a)** — A fetal liver protein. **Q19.** The tumour marker used to diagnose and monitor ovarian cancer is - (a) AFP - (b) CA 19-9 - (c) PSA - (d) CA 125 **Answer: (d)** — Also raised by peritoneal inflammation. **Q20.** The main marker for gestational trophoblastic neoplasia is - (a) CA 125 - (b) CEA - (c) LDH - (d) β-hCG **Answer: (d)** — Includes hydatidiform mole. **Q21.** About what proportion of lung cancers are related to cigarette smoking? - (a) 10% - (b) 85% - (c) 99% - (d) 40% **Answer: (b)** — Leading cancer death worldwide. **Q22.** The commonest histological subtype of lung cancer, especially in never-smokers, is - (a) small cell carcinoma - (b) large cell carcinoma - (c) adenocarcinoma - (d) squamous cell carcinoma **Answer: (c)** — Test for EGFR and other drivers. **Q23.** An apical lung tumour causing shoulder and arm pain is - (a) carcinoid - (b) Pancoast tumour - (c) mesothelioma - (d) hamartoma **Answer: (b)** — Other presentations: SVC syndrome, hoarseness. **Q24.** Small cell lung cancer is characteristically - (a) always curable by surgery - (b) resistant to chemotherapy - (c) initially responsive to treatment but relapses quickly - (d) slow-growing **Answer: (c)** — Chemotherapy ± immunotherapy ± radiotherapy. **Q25.** Annual low-dose CT screening of high-risk adults reduced lung cancer deaths compared with chest X-ray by about - (a) 20% - (b) 2% - (c) 80% - (d) 50% **Answer: (a)** — National Lung Screening Trial. **Q26.** Diagnosis of lung cancer requires - (a) sputum culture - (b) tumour markers - (c) pathological confirmation by tissue sampling - (d) CT appearance alone **Answer: (c)** — Histology and molecular analysis. **Q27.** A patient has episodic flushing, abdominal cramps and diarrhoea with a right-sided heart murmur. The investigation of choice is - (a) serum CEA - (b) VMA - (c) urinary 5-hydroxyindoleacetic acid (5-HIAA) - (d) serum calcitonin **Answer: (c)** — Carcinoid syndrome. **Q28.** A small intestinal neuroendocrine tumour usually causes carcinoid syndrome only when - (a) it is smaller than 1 cm - (b) hepatic metastases are present - (c) the patient is young - (d) it is in the appendix **Answer: (b)** — The liver inactivates serotonin. **Q29.** Symptoms of carcinoid syndrome are controlled with - (a) insulin - (b) propranolol only - (c) allopurinol - (d) somatostatin analogues (octreotide, lanreotide) **Answer: (d)** — Debulking may help. **Q30.** Under India's NP-NCD, population-based screening for oral, breast and cervical cancer covers people aged - (a) 60 years and above - (b) 18 years and above - (c) 50 years and above - (d) 30 years and above **Answer: (d)** — Along with hypertension and diabetes. ### Active Recall From memory: match paraneoplastic syndromes to their tumours, describe spinal cord compression and tumour lysis criteria and treatment, the neutropenia threshold and G-CSF, uses and limits of tumour markers, lung cancer subtypes, presentations and LDCT screening, carcinoid syndrome and NP-NCD cancer screening.