Hypercalcemia and Cancer

[Guest guest]

Hypercalcemia and Cancer

Calcium and Cancer: What's the Connection?

Participants:

• James Berenson, MD

Cedars Sinai Health System, CA

• Lee Rosen, MD

UCLA School of Medicine

• Robert Figlin, MD

UCLA School of Medicine

 

 

When calcium levels rise in people with cancer it may not cause

obvious symptoms but it can cause harmful effects to every organ of

the body. Learn what soaring levels mean and why doctors take this

consequence of cancer seriously.

 

 

 

Webcast Transcript:

 

ANNOUNCER: Calcium is one of the most important and abundant

minerals in the body. But when a person has cancer, the disease can

increase calcium levels, which can prevent the body from fully

processing it. This can cause harmful effects that may require

specific drug treatments. But what is the relationship between

calcium and cancer?

LEE ROSEN, MD: Calcium is one of the chemicals in the body that

regulates a lot of different things, including bone formation and

bone loss, as well as just general metabolism and affecting the many

organs of the body that require calcium for their function.

 

JAMES BERENSON, MD: Hyercalcemia means that the calcium level in the

blood is too high from the leaching out of the bone of calcium, or

the fact that the kidney cannot clear the calcium out of the blood.

 

ANNOUNCER: In cancer patients, high calcium levels by the leaching

of calcium from the bone, can be due to two processes.

 

ROBERT FIGLIN, MD: A hypercalcemia malignancy comes in two forms.

It's a paraneoplastic form, where the cancer cell itself makes a

hormone very much like the hormones that our own body makes to

control calcium. It's something called PTHRP-parathyroid hormone

related protein. The effect of that hormone on bone is to make the

bone leach and release calcium into the bloodstream. This is in

contrast to the hypercalcemia malignancy where the calcium is being

produced because the metastases in the bone are causing the leaching

out of calcium.

 

LEE ROSEN, MD: Hypercalcemia is common enough that we see it

routinely in the clinic. Cancers of the breast, the prostate, the

lung, multiple myeloma, disease of the bone marrow, all of these can

be associated with high blood calcium levels.

 

JAMES BERENSON, MD: When calcium is too high in the blood it can

affect every major organ in the body it affects the kidney, heart

function, the GI tract, your thinking function, your nerves, and the

rest of your body.

 

ANNOUNCER: There are effective treatments available for patients

with hypercalcemia to discuss with their doctor.

 

LEE ROSEN, MD: Usually the best thing to do for hypercalcemia is to

use bisphosphonate therapy. This is a class of drugs that's been

around for several years now, the standards being either Aredia,

another new, stronger, drug Zometa.

 

JAMES BERENSON, MD: These drugs reduce bone loss. And of course,

with the reduction in bone loss there's less calcium leaching out of

the bone, and thus less calcium in the blood to cause hypercalcemia

in these patients.

 

The older bisphosphonates such as etidronate and clodronate reversed

calcium in maybe half of the cases. Whereas the newer agents, such

as pamidronate and zoledronic acid, were able to normalize calcium

in most patients. However it is very clear from a recent randomized

trial that was done comparing zoledronic acid to pamidronate that

zoledronic was much more effective at reversing calcium in the blood

of cancer patients.

 

LEE ROSEN, MD: The bisphosphonates are very effective in the long-

term control of hypercalcemia. Usually they take a couple of days to

start working, so while they're taking their effects, you can use

very vigorous intravenous hydration, fluid, to flush the calcium

almost out of the body and chase it with some diurectics to promote

excreting the calcium through the urine.

 

ANNOUNCER: Like many medications, there can be some side effects

with bisphosphonates.

 

JAMES BERENSON, MD: All of the bisphosphonates can cause kidney

problems if given at too high a dose, too frequently, or too

rapidly.

 

One of the troubling things with high calcium or hypercalcemia is

that commonly this is diagnosed very late, because of the non-

specificity of the symptoms. Some patients present that they're kind

of tired, they have constipation and they could be nauseated, and

these are pretty nonspecific symptoms, and they can be related

either to other things that are going on with their cancer, or

possibly the treatment we use.

 

It's very important to diagnose this early because this can lead to

very, very serious complications. They include coma and eventual

death. And in addition, the kidneys can be affected, and

irreversible kidney failure can occur.

 

ANNOUNCER: But with new treatment options, physicians can help

prevent hypercalcemia from becoming a life-threatening illness, and

improve quality of life for cancer patients during the course of

their disease.

 

JAMES BERENSON, MD: The bisphosphonates have very much changed the

way we deal with high calcium in our cancer patients. It was pretty

universal to put these patients in the hospital and monitor them

over several days. Now many of these patients can be simply

monitored with some IV fluids in the clinic and then given their

dose of bisphosphonate, and then check their calcium every few days

until one is assured that they are coming back to normal.

_________________

JoAnn Guest

mrsjoguest

DietaryTipsForHBP

http://www.geocities.com/mrsjoguest

 

 

 

 

 

 

 

 

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