RHEUMATIC MANIFESTATIONS OF OCCULT CANCER

Background. The frequency with which rheumatic disorders occur when ma lignant neoplasms first present is unknown, and the significance of rh eumatic conditions as cancer markers is unappreciated. Methods. Patien ts admitted to a medical ward of a general hospital (Bnai Zion Medical Center, Haifa, Israel) during a 10-year period were surveyed. The fre quency of the diagnostic evaluation of rheumatic disorders resulting i n uncovering occult neoplasia at the time of index hospitalization and during the 2-year follow-up period was assessed. Results, The inciden ce of occult cancer among patients admitted to a general medical ward with previously unclarified rheumatic disorders was 23.1%. Seventy-two percent of the group of patients with rheumatic diseases and occult c ancer were male; 69% with rheumatic disease without cancer (control gr oup) were female. The median age in the group with occult cancer was a n average of 10 years older than the group without cancer, 67 versus 5 7 years (P < 0.001). Weight loss or anemia occurred in 52% of the grou p with occult cancer and in 37.3% of the control cases (not significan t). Typically, there were no distinguishing features of the rheumatic syndromes suggesting the coexistence of cancer. In 19 of 25 cases, the malignancy was uncovered by routine examinations. In four instances, neoplasia was not immediately apparent but was identified in a specifi c search. In two cases, no search for malignancy initially was underta ken, and Hodgkin's lymphoma was diagnosed 6 and 12 months later. In 9 of 25 cases, long term remission of neoplasia was achieved by cancer t herapy with improvement of rheumatic manifestations coinciding with re gression. Conclusions. A significant number of patients who are referr ed to a general medical ward for evaluation of previously unclassified rheumatic disorders may be found to have a previously undetected mali gnancy. For most patients, the symptoms of cancer are found by routine physical and laboratory examinations. The importance of the associati on of rheumatic disorders and malignancy requires greater awareness, a ppreciation, and clinical study.