|NCI/PDQ® Patients: Hypercalcemia (PDQ®)|
|National Cancer Institute|
| Last Modified: November 9, 2012
Normal, healthy kidneys help the body keep the amount of calcium it needs. The kidneys can remove large amounts of calcium from the blood and pass the extra calcium into the urine.
Most of the calcium in the body is in bone, but bone has only a small role in keeping the balance of calcium in the body.
When calcium is out of balance, the whole body is affected. If hypercalcemia is not treated, it will get worse and can lead to a coma and death. Early diagnosis and treatment are very important and can be lifesaving and may help you continue your cancer treatment and improve your quality of life.
Hypercalcemia (too much calcium in the blood) is the most common life-threatening complication of cancer occurring in 10% to 20% of adults and rarely in children. Hypercalcemia occurs most often in patients with:
The symptoms of hypercalcemia may occur slowly and may look like other illnesses, making it hard to diagnose. Early diagnosis and treatment may improve symptoms in a few days.
Some cancer cells cause the kidneys to return calcium to the blood after filtering it, instead of passing the extra calcium out of the body in urine. The kidneys keep making urine as they try to get rid of the extra calcium, and this causes the body to be dehydrated (not enough fluid). Dehydration can lead to the following:
Cancer patients are often too tired and weak to be as active as usual. Being inactive can increase calcium in the blood because bones release calcium when they are not being used. Also, some blood cancers make substances that cause bone to break down and release calcium into the blood.
Hormone therapy can also increase the amount of calcium in the blood.
Hypercalcemia symptoms may differ between patients. They can appear slowly over time and may look like symptoms of cancer and other diseases. The most common symptoms of hypercalcemia include the following:
Hypercalcemia can affect many organs of the body and symptoms depend on which organs are affected.
Sometimes mental problems need treatment separate from the treatment for hypercalcemia.
Hypercalcemia affects normal heart rhythms. It can also make the heart more sensitive to certain heart medicines (such as digoxin). Calcium levels that are higher than normal can cause irregular heartbeats or a heart attack.
Constipation may become worse if you are not drinking enough fluids.
Patients with multiple myeloma often have kidney problems because of hypercalcemia. Kidney stones may form if hypercalcemia lasts a long time.
Hypercalcemia can be caused by cancer spreading to the bone or by bone loss. Bones may be painful or break.
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about hypercalcemia that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Hypercalcemia can be very serious and can cause death. It is important to learn how to recognize it early and manage it carefully. Patients at risk of hypercalcemia may be the first to notice its symptoms, such as fatigue. Ask your doctor if you are at risk for hypercalcemia and learn about the following:
Severe hypercalcemia should be treated right away. Less severe hypercalcemia is treated based on the symptoms. The treatment is working if the symptoms of hypercalcemia disappear and the level of calcium in the blood decreases.
After calcium levels return to normal, urine and blood samples will be checked often to make sure the treatment is still working.
Patients with mild hypercalcemia may not have any symptoms and usually do not need agressive treatment. If you have no symptoms of hypercalcemia and your cancer responds well to anticancer treatment, treatment for hypercalcemia may include:
If you have symptoms of hypercalcemia or your cancer is not expected to respond quickly to treatment, treatment for the hypercalcemia may include the following:
Mental changes may take some time to get better, even after calcium levels return to normal. Usually, treatment of hypercalcemia will stop delirium, agitation, and mental changes, but some patients may need other medicines to treat these symptoms. (See the PDQ® summary on Cognitive Disorders and Delirium for more information.)
Lethargy (feeling sluggish) is often a symptom of hypercalcemia. Family members (and sometimes medical staff) may think lethargy is depression until the actual cause is found. Most patients with lethargy will show little energy or interest in life. However, patients with lethargy will not have symptoms of depression (such as hopelessness, helplessness, guilt, worthlessness, or thoughts of suicide). It is important to know the difference between depression and lethargy so that the right treatment is given.
Hypercalcemia can make it hard to think clearly. Your choices about cancer care and treatment should be made when you are clearly able to decide for yourself. Untreated hypercalcemia will get worse and cause loss of consciousness and coma. Some patients who have advanced terminal cancer and are no longer getting treatment for the cancer may choose not to be treated for hypercalcemia.
Supportive care can also comfort family members who may become upset by the changes hypercalcemia causes in their loved one's thinking and behavior.
Hypercalcemia can affect your quality of life and be life threatening if not treated right away. You and your caregiver should learn the symptoms to look for and report them to your doctor as soon as they occur. Staying active and drinking plenty of fluids will help prevent hypercalcemia. See the Symptoms of Hypercalcemia section for hypercalcemia symptoms.
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about hypercalcemia of malignancy that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
This summary was completely reformatted and some content was added.
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