Rheumatic disorders - clues to occult neoplasia

Interest in the rheumatologic manifestations of cancer is related in part by practical considerations, i.e. earlier cancer diagnosis is possible through enhanced awareness of cancer-associated rheumatic syndromes. The spectrum of rheumatic disorders associated with cancer includes over 30 conditions. Patients admitted to the medical ward of our general hospital over a 10 year period were surveyed. The frequency with which the diagnostic evaluation of rheumatic disorders resulted in uncovering occult neoplasia at the time of index hospitalization and during two year follow-up was assessed. The incidence of occult cancer among patients admitted with a poorly defined rheumatic disorders was 23.1%. The group of rheumatic patients with occult cancer (n=25) was characterized by male predominance (72%); the patientʹs median age was 67 years. In rheumatic patients without cancer (n=83), the women predominated (69%) and the median age in this group was 57 years (p<0.001). Weight loss or anemia was present in 52% of the occult cancer and in 37.3% of the control cases (NS). Typically, there were no distinguishing features of the rheumatic syndromes to suggest the coexistence of cancer. It is generally held, as shown by our series, that extensive search for occult malignancy in most rheumatic disorders is not cost efficient and not recommended unless accompanied by specific findings suggestive of malignancy. The supplementary findings that may justify malignancy evaluation are discussed.