Chapter 22 - Cancer-associated plexopathy

Abstract

Despite the development of new therapies and related neurological complications, the two main considerations in patients with a history of cancer presenting with a brachial or lumbar plexopathy is neoplastic plexopathy or radiation-induced plexopathy. A focused cancer history and neurological examination can aid in localization and in narrowing down the differential diagnosis. Cancer-related plexopathies are more common, tend to be painful, and have a more rapid onset than radiation-induced plexopathies, which present in a more indolent fashion over the course of months to years following radiation therapy. Although imaging is helpful to visualize the degree of plexus involvement and to assess for locoregional disease, and systemic staging, it may be hard to distinguish the two on the basis of imaging alone. Nerve conduction studies and electromyography can be useful if myokymic changes are present as these are associated with radiation-induced plexopathies. Unfortunately, both types of plexopathies are treated with supportive measures, and survival and quality of life may be limited in many of the affected patients.