A new study shows that many patients with testicular cancer develop paraneoplastic neurologic syndromes (PNS) before their cancer is detected. These early symptoms often include ataxia, hearing loss, and vertigo.
Study Details
PNS can occur in men with testicular germ cell tumors. Identifying these neurologic syndromes early may help reduce long-term disability.
Researchers at the Mayo Clinic reviewed records from 49 patients treated for both conditions. The median age was 41 years. Most patients had seminomas (67%). Nine had nonseminomatous tumors, and seven had tumors that had already regressed.
Forty-five patients had definite PNS. Four had probable cases. Blood and cerebrospinal fluid samples were tested for neural antibodies such as KLHL11-IgG, LUZP4-IgG, and Ma2-IgG.
The team collected clinical and demographic information and followed patients for a median of 33 months after diagnosis.
Major Findings
About 80% of patients developed neurological symptoms before their cancer diagnosis.
Common symptoms included:
- Ataxia (63%)
- Double vision (59%)
- Sensorineural hearing loss (45%)
- Vertigo (41%)
Patients with nonseminomatous tumors more often experienced sleep problems and seizures.
Neural autoantibodies were found in 94% of patients. KLHL11-IgG was the most common, appearing in 32 patients. It was strongly linked to seminomas. Ma2-IgG was more common in nonseminomatous tumors.
Ma2-IgG was also linked to sleep disturbance and seizures. KLHL11-IgG was linked to hearing loss and tinnitus.
Although 80% of patients reached remission or cure, neurologic recovery was uncommon. Only 16% improved. Forty-three percent stabilized, while 41% worsened despite immunotherapy. Nine patients died, and PNS directly caused six of these deaths.
Conclusion
The authors note that early neurological symptoms in younger men should prompt testing for neural antibodies and evaluation for possible hidden malignancy, especially testicular germ cell tumors. For patients already diagnosed with testicular cancer, early recognition of PNS may prevent long-term neurological damage.
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