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Plexopathies in cancer patients

Plexopathies in cancer patients
Syndrome Description
Cervical plexopathy Aching and burning pain in periauricular or postauricular area, or anterior neck
Pain may be referred to the lateral aspect of the face, head, or shoulder
Brachial plexopathy Moderate to severe pain with component that is dysesthetic and described as burning or freezing
Allodynia may accompany pain
Lumbosacral plexopathies Presents as pain, followed by numbness, paresthesias, or weakness
Other symptoms include focal tenderness, leg edema, and positive direct or reverse straight leg raising signs
Distribution of pain is related to the location of the neoplasm:
- Upper lumbosacral plexopathy (L1-4): Pain experienced in the anterolateral thigh, knee, and proximal leg/lower abdomen; generally caused by low abdominal tumors; upper lumbosacral plexopathy associated with malignant involvement of the psoas major muscle is termed "malignant psoas syndrome"
- Lower lumbosacral plexopathy (L4-S1): Pain may be focal in buttocks and perineum and referred to posterolateral thigh and leg; weakness or sensory changes in L5 and S1 dermatomes; leg edema, bladder dysfunction, or bowel dysfunction; generally caused by sigmoid or rectal tumors
- Sacral plexopathy (S1-3): May lead to dysesthesias in buttocks, perineum, or posterior legs; pain often severe while sitting, less severe while standing, and least severe while walking; numbness over the dorsolateral foot and weak ankle dorsiflexion; mostly associated with low midline tumors (eg, rectal cancer)
- Panplexopathy: Pain anywhere from lower abdomen, back, buttocks, or perineum; referred pain experienced anywhere in the distribution of the plexus
- Coccygeal plexopathy (S4-coccygeal nerve): May present as anal pain, numbness, and sphincter dysfunction; most common with rectal and prostate tumors
Plexopathies_cancer_pts.htm
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