title: Screening for tumours in paraneoplastic syndromes: report of an EFNS task force.
abstract: BACKGROUND
  paraneoplastic neurological syndromes (PNS) almost invariably predate detection of the malignancy. Screening for tumours is important in PNS as the tumour directly affects prognosis and treatment and should be performed as soon as possible.
  
  
  OBJECTIVE
  an overview of the screening of tumours related to classical PNS is given. Small cell lung cancer, thymoma, breast cancer, ovarian carcinoma and teratoma and testicular tumours are described in relation to paraneoplastic limbic encephalitis, subacute sensory neuronopathy, subacute autonomic neuropathy, paraneoplastic cerebellar degeneration, paraneoplastic opsoclonus-myoclonus, Lambert-Eaton myasthenic syndrome (LEMS), myasthenia gravis and paraneoplastic peripheral nerve hyperexcitability.
  
  
  METHODS
  many studies with class IV evidence were available; one study reached level III evidence. No evidence-based recommendations grade A-C were possible, but good practice points were agreed by consensus.
  
  
  CONCLUSIONS
  the nature of antibody, and to a lesser extent the clinical syndrome, determines the risk and type of an underlying malignancy. For screening of the thoracic region, a CT-thorax is recommended, which if negative is followed by fluorodeoxyglucose-positron emission tomography (FDG-PET). Breast cancer is screened for by mammography, followed by MRI. For the pelvic region, ultrasound (US) is the investigation of first choice followed by CT. Dermatomyositis patients should have CT-thorax/abdomen, US of the pelvic region and mammography in women, US of testes in men under 50 years and colonoscopy in men and women over 50. If primary screening is negative, repeat screening after 3-6 months and screen every 6 months up till 4 years. In LEMS, screening for 2 years is sufficient. In syndromes where only a subgroup of patients have a malignancy, tumour markers have additional value to predict a probable malignancy.
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, Netherlands. m.j.titulaer@lumc.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Titulaer
authors.forename: R
authors.initials: R
authors.lastname: Soffietti
authors.forename: J
authors.initials: J
authors.lastname: Dalmau
authors.forename: N E
authors.initials: NE
authors.lastname: Gilhus
authors.forename: B
authors.initials: B
authors.lastname: Giometto
authors.forename: F
authors.initials: F
authors.lastname: Graus
authors.forename: W
authors.initials: W
authors.lastname: Grisold
authors.forename: J
authors.initials: J
authors.lastname: Honnorat
authors.forename: P A E
authors.initials: PA
authors.lastname: Sillevis Smitt
authors.forename: R
authors.initials: R
authors.lastname: Tanasescu
authors.forename: C A
authors.initials: CA
authors.lastname: Vedeler
authors.forename: R
authors.initials: R
authors.lastname: Voltz
authors.forename: J J G M
authors.initials: JJ
authors.lastname: Verschuuren
mesh_terms: D000906:Antibodies / Q000276:immunology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000276:immunology; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000276:immunology
chemical_list: D000906:Antibodies