Prevention
Managing hypercalcemia
Mild hypercalcemia
Moderate to severe hypercalcemia
Patient and family education
Supportive care
Psychosocial management
Prognosis

Prevention

Patients at risk of developing hypercalcemia may be the first to recognize its symptoms, such as fatigue. Measures to prevent hypercalcemia include drinking enough fluids, controlling nausea and vomiting, walking and being active, and cautious use or elimination of drugs that can contribute to the development of hypercalcemia or affect its treatment. Calcium in the diet should not be reduced or eliminated, however, because the body's absorption of calcium is reduced in patients with hypercalcemia.

Fluids are given to treat dehydration. Medication is given to stop the breakdown of bone. The cancer causing the hypercalcemia should be treated effectively.

The severity of the hypercalcemia determines the amount of treatment necessary. Severe hypercalcemia should be treated immediately and aggressively. Less severe hypercalcemia should be treated according to the symptoms. Response to treatment is shown by the disappearance of the symptoms of hypercalcemia and a decrease in the level of calcium in the blood.

Mild hypercalcemia does not usually need to be treated aggressively. Patients with mild hypercalcemia and central nervous system symptoms are harder to treat. Younger patients are especially difficult to treat because they tolerate hypercalcemia better. Other causes of the central nervous system symptoms should be ruled out before deciding that they are caused by hypercalcemia alone.

Treatment for hypercalcemia can improve symptoms. Increased urination and thirst, central nervous system symptoms, nausea, vomiting, and constipation improve with treatment more easily than other symptoms, such as loss of appetite, and tiredness. Pain may be more easily controlled once calcium levels are normal. Effective therapy that lowers calcium usually improves symptoms, enhances the quality of life, and may allow the patient to leave the hospital.

After calcium levels return to normal, urine and blood should continue to be checked often to make sure the treatment is still working.

Giving fluids by vein and observing the patient is an accepted treatment for patients with mild hypercalcemia (but no symptoms) and who also have cancer that responds well to anticancer treatment (such as lymphoma, breast cancer, ovarian cancer, head and neck cancers, or multiple myeloma). If the patient has symptoms, or has a cancer that is expected to respond slowly to treatment, then drugs to treat the hypercalcemia should be started. Other treatments should focus on controlling nausea, vomiting, and fever, encouraging continued activity, and limiting use of drugs that cause sleepiness.

Replacing fluids is the first and most important step in treating moderate or severe hypercalcemia. Replacing fluids will not restore normal calcium levels in all patients, but it is still important to do first. The patient's mental state should improve, and nausea and vomiting should decrease within the first 24 hours, but this improvement is only temporary. If cancer therapy (surgery, radiation, or chemotherapy) is not able to be started immediately, then drugs to lower the calcium levels must be used to control the hypercalcemia.

Drugs that may help stop the breakdown of bone include calcitonin, plicamycin (mithramycin), bisphosphonates (etidronate, pamidronate, and clodronate), and gallium nitrate. Steroids and phosphate may also be used to treat hypercalcemia. Dialysis is used as a treatment for hypercalcemia in patients with kidney failure. Other drugs are currently being studied as possible treatments for hypercalcemia. Combinations of drugs may also be used.

Because hypercalcemia affects quality of life and can be life-threatening if not treated, patients and their caregivers should be aware of the symptoms. They should also learn how to prevent hypercalcemia, what can make it worse, and when to see the doctor.

Even with improved treatment for hypercalcemia, many patients do not survive this complication of cancer. Only effective anticancer therapy improves the patient's chances for long-term survival.

Supportive care includes measures to provide the patient with protection from injury, prevention of fractures, and treatment of symptoms.

Treatment of symptoms is important, especially the prevention of accidental or self-inflicted injury if a patient is confused. Nausea, vomiting, and constipation may also need to be controlled until calcium levels go down. Broken bones may occur due to weakening, so patients need to be moved gently, and falling must be prevented. Activity and weight-bearing exercises should be encouraged. Any new bone pain should be reported so that it can be evaluated for possible fractures.

Supportive care to comfort terminally ill patients and their family members becomes necessary in the last stages of the disease. Changes in the patient's thinking and behavior may especially upset the family.

Usually, treatment of the hypercalcemia will eliminate delirium, agitation, or mental changes, but some patients may need other medications to treat these symptoms. (See the PDQ summary on Cognitive Disorders and Delirium ¹ for more information.) Mental changes may take some time to get better, even after calcium levels return to normal.

Lethargy (mental and physical sluggishness) is often a symptom of hypercalcemia. Family members (and sometimes medical staff) may think that the patient is depressed until the actual cause is determined. Most patients will not have symptoms of depression (such as hopelessness, helplessness, guilt, worthlessness, or thoughts of suicide) and instead will appear to be indifferent.

Patients and family members should report symptoms of hypercalcemia such as lethargy, fatigue, confusion, loss of appetite, nausea/vomiting, constipation, and excessive thirst to the health care provider.

Hypercalcemia usually develops as a late complication of cancer, and its appearance is very serious. However, it is not clear if death occurs due to a hypercalcemia crisis (uncontrolled or one that comes back and gets worse) or due to the advanced cancer.

Glossary Terms

The process of taking nutrients from the digestive system into the blood so they can be used in the body.

Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.

A condition in which a person is unable to relax and be still. The person may be very tense and irritable, and become easily annoyed by small things. He or she may be eager to have an argument, and be unwilling to work with caregivers to make the situation better.

A desire to satisfy a physical or mental need, such as for food, sex, or adventure.

A drug or substance used to treat hypercalcemia (abnormally high blood calcium) and bone pain caused by some types of cancer. Forms of bisphosphonates are also used to treat osteoporosis and for bone imaging. Bisphosphonates inhibit a type of bone cell that breaks down bone. Also called diphosphonate.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A hormone formed by the C cells of the thyroid gland. It helps maintain a healthy level of calcium in the blood. When the calcium level is too high, calcitonin lowers it.

A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The brain and spinal cord. Also called CNS.

Treatment with drugs that kill cancer cells.

A drug used in the treatment of hypercalcemia (abnormally high levels of calcium in the blood) and cancer that has spread to the bone (bone metastases). It may decrease pain, the risk of fractures, and the development of new bone metastases.

In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.

A mental state in which one is not thinking clearly.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

A mental state in which a person is confused, disoriented, and not able to think or remember clearly. The person may also be agitated and have hallucinations, and extreme excitement.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of filtering the blood when the kidneys are not able to cleanse it.

The things a person eats and drinks.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A drug that belongs to the family of drugs called bisphosphonates. Bisphosphonates are used as treatment for hypercalcemia (abnormally high levels of calcium in the blood) and for cancer that has spread to the bone (bone metastases).

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An increase in body temperature above normal (98.6 degrees F), usually caused by disease.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

A drug that lowers blood calcium. Used as treatment for hypercalcemia (too much calcium in the blood) and for cancer that has spread to the bone (bone metastases).

Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).

Higher than normal levels of calcium in the blood. Some types of cancer increase the risk of hypercalcemia.

A condition in which the kidneys stop working and are not able to remove waste and extra water from the blood or keep body chemicals in balance. Acute or severe kidney failure happens suddenly (for example, after an injury) and may be treated and cured. Chronic kidney failure develops over many years, may be caused by conditions like high blood pressure or diabetes, and cannot be cured. Chronic kidney failure may lead to total and long-lasting kidney failure, called end-stage renal disease (ESRD). A person in ESRD needs dialysis (the process of cleaning the blood by passing it through a membrane or filter) or a kidney transplant. Also called renal failure.

A condition marked by drowsiness and an unusual lack of energy and mental alertness. It can be caused by many things, including illness, injury, or drugs.

Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A person’s overall psychological and emotional condition. Good mental health is a state of well-being in which a person is able to cope with everyday events, think clearly, be responsible, meet challenges, and have good relationships with others.

A type of cancer that begins in plasma cells (white blood cells that produce antibodies). Also called Kahler disease, myelomatosis, and plasma cell myeloma.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and watchful waiting.

Cancer that forms in tissues of the ovary (one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).

A drug that is used to treat hypercalcemia (too much calcium in the blood) and cancer that has spread to the bones. It belongs to the family of drugs called bisphosphonates.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

A substance that contains phosphorus, a nonmetal chemical element. Phosphate may be used to treat a high level of calcium in the blood.

A drug used to treat some types of testicular cancer. It is also used to treat a higher-than-normal amounts of calcium in the blood or urine. Plicamycin binds to DNA and prevents cells from making RNA and proteins. It is a type of antineoplastic antibiotic. Also called Mithracin and mithramycin.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

In medicine, an improvement related to treatment.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and symptom management.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Disease that cannot be cured and will cause death.

Treatment.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.

A blood vessel that carries blood to the heart from tissues and organs in the body.

To eject some or all of the contents of the stomach through the mouth.