Diagnosis Score of Lortholary et al for a Paraneoplastic Syndrome

Parameters:

(1) presence of cancer

(2) relationship between symptoms and direct mechanical effect of the primary tumor or its metastases

(3) presence of an alternative explanation for the findings

(4) evolution of symptoms relative to tumor

where:

• Sometimes a very small tumor may not be detected until weeks or months after onset of symptoms. This can be seen with small cell undifferentiated neuroendocrine ("oat cell") carcinomas of the lung.

• Symptom severity parallels tumor extent if worse with an increase in tumor burden or if better with tumor regression.

total score =

= SUM(points for all 4 parameters)

Interpretation:

• minimum score: 0

• maximum score: 4

• A score of 4 indicates that a paraneoplastic syndrome is certain.

• A score of 3 indicates that a paraneoplastic syndrome is probable, unless the syndrome can be demonstrated to be due to a direct tumor effect.

Limitations:

• My confidence in the diagnosis would be increased if the paraneoplastic syndrome has been well-described. My confidence would be lower if the relationship had never been described before.