Hypercalcemia (Elevated Blood Calcium Level)
What is hypercalcemia?
Hypercalcemia happens when there is a high level of calcium in your blood. Calcium is a mineral stored in the bones. Calcium helps:
- Keep your bones healthy.
- Your muscles and heart work.
- You body make blood clots.
Hypercalcemia happens in about 10-20% of patients with cancer, usually those with advanced or late-stage cancers. Hypercalcemia is most common in breast and lung cancer, myeloma, lymphoma, and other blood cancers.
Hypercalcemia is an oncologic emergency, which is a serious health problem caused by the cancer itself or its treatment. Oncologic emergencies need to be treated right away.
What causes hypercalcemia?
Hypercalcemia may be caused by:
- Bone breakdown. This causes the release of high levels of calcium into the bloodstream, especially cancers in the bone (myeloma) or that have spread to the bone.
- Some cancers affect organs and protein levels, increasing the levels of calcium in the blood.
- Some medications, including alkaline antacids, diuretics, estrogens, and progesterone, can affect calcium levels.
- Dehydration (not enough fluid in your body).
- Less active lifestyle.
What are the symptoms of hypercalcemia?
Hypercalcemia does not always cause obvious symptoms. In some cases, it is found through lab test results. If you have symptoms, they may be:
- Not feeling hungry.
- Nausea and vomiting.
- Abdominal (belly) pain.
- Increased thirst.
- Urinating more often.
- Fatigue, weakness, and muscle pain.
- Feeling disoriented, confused, or having a hard time processing thoughts.
- Depressed mood.
How is it treated?
There are three degrees of hypercalcemia: mild, moderate, and severe. The level is based on the results of laboratory tests that measure the level of calcium in the blood. The degree of hypercalcemia sets the treatment plan. Because hypercalcemia is often caused by cancer, treating the underlying cancer is important.
Treatments can include:
- IV (intravenous, into a vein) fluids.
- Medications to lower the level of calcium in the blood and prevent further bone breakdown (including calcitonin, denosumab, bisphosphonates, and steroids).
- Hypercalcemia can cause kidney damage. Dialysis may be needed in severe cases. Dialysis filters your blood through a machine when your kidneys aren’t working as they should.
Untreated hypercalcemia can lead to serious health problems, such as loss of consciousness, heart arrhythmia, and heart attack.
When should I call my care team?
Call your care team right away if you are having any of the symptoms of hypercalcemia listed above.
American Society of Clinical Oncology (ASCO). (2020). High Calcium Levels or Hypercalcemia. Taken from https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/high-calcium-levels-or-hypercalcemia
Ghada El-Hajj Fuleihan, Gregory A Clines, Mimi I Hu, Claudio Marcocci, M Hassan Murad, Thomas Piggott, Catherine Van Poznak, Joy Y Wu, Matthew T Drake, Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 3, March 2023, Pages 507–528, https://doi-org.proxy.library.upenn.edu/10.1210/clinem/dgac621
Goldner, W. (2016). Cancer-related hypercalcemia. https://ascopubs.org/doi/pdf/10.1200/JOP.2016.011155
Guise, T. A., & Wysolmerski, J. J. (2022). Cancer-Associated Hypercalcemia. Reply. The New England Journal of Medicine, 386(26), 2540–2540. https://doi.org/10.1056/NEJMc2206287
Nursing Times. (2018). Malignant hypercalcemia: definition, symptoms and treatment. https://www.nursingtimes.net/clinical-archive/cancer-clinical-archive/malignant-hypercalcaemia-definition-symptoms-and-treatment-08-10-2018/