Identifying the causes of peripheral neuropathy in cancer patients can be difficult. There are many common causes of peripheral neuropathy in cancer patients.
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system. Peripheral neuropathies arise from disorders associated specifically within the peripheral nervous system. Symptoms of peripheral neuropathy can include numbness, tingling, pins and needles sensations, sensitivity to touch, or muscle weakness.
There are multiple causes of peripheral neuropathy in patients with cancer, identifying the culprit may be complicated by a plethora of etiologies. The peripheral neuropathy can originate from the cancer itself, from the medications, or a combination thereof. According to statistics about 11.9 million American cancer patients deal with cancer pain, a portion of which is peripheral neuropathic.
Cancer Induced Peripheral Neuropathy
Cancer alone can cause peripheral neuropathy pain. Certain neuropathies can develop due to remote or paraneoplastic effect; invasion of the cancer or compression of the nerves; or as a side effect secondary to treatment.
PEN/SN
Paraneoplastic encephalomyelitis/sensory neuronopathy (PEN/SN) is a type of neuropathy most commonly associated with lung cancer, such as small-cell lung cancer. Unlike other types of pain syndromes, PEN/SN is not due to the effects of the tumor itself, metastasis, treatment, infection, or metabolic abnormalities. Rather, it is thought to be a result of “remote effects” of the cancer that lead to the production of antibodies or inflammatory cells against any neural antigens that the tumor may express.
Tumor Infiltration
Peripheral neuropathy may also develop secondary to tumor infiltration. Leukemia and lymphoma cells can infiltrate the cranial and peripheral nerves. This neuropathy is generally painful and may be an indication of newly diagnosed cancer and/or disease progression.
Lymphoma
Lymphoma often causes neuropathy either by infiltrating or directly compressing nerves. Although the NHL neuropathy may also manifest as a sensory or motor symptom, and it is also commonly seen as a sensorimotor neuropathy. How the neuropathy shows up in patients may be acute, gradually progressive, or relapsing and remitting.
Multiple Myeloma
About 40% of patients with MM develop some type of peripheral neuropathy. Patients may develop painful paresthesia and loss of differentiating between pinprick and temperature sensations.
Waldenström’s Macroglobulinemia
Waldenström’s macroglobulinemia is a cancer of the B lymphocytes. It is caused by a malignant proliferation of lymphoplasmacytoid cells, which produces an overabundance of immunoglobulin M monoclonal proteins with a κ light chain—causing the blood to become hyperviscous. The mechanism of neuropathy is unknown, but it’s thought to be related to myelin-associated glycoprotein antibodies. However, a causal relationship has not been confirmed.6
Solid Tumors
The most common solid tumors associated with peripheral neuropathy include breast cancer and lung cancer.