Paraneoplastic neurological syndromes as a diagnostic and therapeutic challenge in colorectal cancer: The role of neurologists in interdisciplinary care

Colorectal cancer (CRC) is one of the most common malignant neoplasms, characterized by high mortality and ranking among the leading causes of cancer-related deaths. It remains a major focus of gastroenterologists and oncologists. However, modern clinical practice increasingly promotes multidisciplinary teams, improving early diagnosis and treatment outcomes. Despite advances in oncologic diagnostics, cooperation with neurologists remains insufficient, although their role is crucial in detecting and managing post-treatment complications and paraneoplastic neurological syndromes (PNS). The prevalence of PNS is estimated at ~0.01% in the oncologic population, though likely underestimated due to limited neurological evaluation. Neurological symptoms may precede CRC diagnosis, yet their nonspecific nature often leads to misinterpretation and diagnostic delay. This article reviews studies on paraneoplastic neurological syndromes in colorectal cancer, emphasizing the neurologist’s role in oncologic diagnostics. A systematic search was performed in PubMed, Scopus, and Web of Science (2000-2025), covering case reports and clinical studies. The most frequently described PNS include paraneoplastic cerebellar degeneration, stiff-person syndrome, limbic encephalitis, and chronic inflammatory demyelinating polyneuropathy. Proper diagnosis differentiates disease progression from treatment complications. Notably, neurological symptoms may precede tumour detection by months and serve as early warning markers. In diagnosed cases, regular neurological follow-up enables earlier detection of new symptoms and better assessment of recurrence risk. Accurate interpretation of neurological signs requires close interdisciplinary collaboration, particularly with neurologists, who must maintain high diagnostic vigilance for atypical neurological presentations that may indicate an underlying malignancy.