Introduction
Overview

Normal calcium regulation Kidney function

Causes
Incidence
Symptoms

Nervous system Heart Gastrointestinal Kidney Bone

Assessment

Laboratory assessment Clinical assessment Decision to treat

Treatment

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

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Changes to This Summary (12/08/2008)
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About PDQ

Introduction

This patient summary on hypercalcemia is adapted from the PDQ summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Hypercalcemia is a disorder in which the level of calcium in the blood is too high. Hypercalcemia is the most common life-threatening disorder associated with cancer. This brief summary describes hypercalcemia, its causes and treatment.

Overview

Hypercalcemia occurs in 10%-20% of people with cancer, although it occurs much less often in children. The cancers most often associated with hypercalcemia are cancer of the breast and lung, as well as certain cancers of the blood, particularly multiple myeloma. Early diagnosis and treatment with fluids and drugs that lower calcium levels in the blood can improve symptoms in a few days, but diagnosis may be difficult. Symptoms of hypercalcemia can appear gradually and may resemble symptoms of many cancers and other diseases. Early diagnosis and treatment are not only lifesaving in the short term, but may also increase the patient's ability to complete cancer therapy and improve the patient's quality of life.

Patients who have advanced terminal cancer and are no longer receiving treatment for the cancer may choose not to be treated for hypercalcemia. This option should be considered by a patient and his or her family in advance, before symptoms of hypercalcemia occur.

Healthy people consume about the same amount of calcium in their diet as their bodies lose in urine, feces, and sweat. Hypercalcemia associated with cancer disrupts the body's ability to maintain a normal level of calcium.

Normal, healthy kidneys are able to filter large amounts of calcium from the blood, excrete the excess not needed by the body, and retain the amount of calcium the body does need. However, hypercalcemia may cause such high levels of calcium in the body that the kidneys are overworked and become unable to excrete the excess. Some tumors produce a substance that can cause the kidneys to excrete too little calcium. This results in a large amount of urine being produced, which then causes dehydration. Dehydration may lead to appetite loss, nausea, and vomiting, which make the dehydration worse. Inactivity caused by weakness and tiredness may increase the amount of calcium in the blood by increasing the amount of calcium that is absorbed from the bones. Calcium deposits may collect in the kidneys, causing permanent damage.

Causes

The main causes of hypercalcemia due to cancer are an increase in the amount of calcium absorbed from the bones, and an inability of the kidneys to excrete excess calcium. Some cancer cells secrete substances that cause calcium to be absorbed into the bloodstream from bones. Immobility, dehydration, anorexia, nausea, and vomiting may also increase calcium levels.

Incidence

Hypercalcemia occurs most frequently in patients with lung and breast cancer. It may also occur in patients with multiple myeloma, head and neck cancer, cancer of unknown primary origin, lymphoma, leukemia, kidney cancer, and gastrointestinal cancer.

Symptoms

There is little relationship between symptoms of hypercalcemia and the actual level of calcium in the blood. Symptoms of hypercalcemia resemble symptoms of other illnesses, making an early and rapid diagnosis difficult. The severity of the symptoms may depend on other factors, such as previous cancer treatment, reactions to drugs, or other illnesses a patient may have.

Most patients do not experience all of the symptoms of hypercalcemia, and some patients may not have any symptoms at all. However, most patients with high calcium levels in the blood do have symptoms. Some patients develop signs of hypercalcemia when calcium levels are only slightly high, while patients who have had higher calcium levels for a long time may show few symptoms.

The most common symptoms of hypercalcemia are feeling tired, difficulty thinking clearly, lack of appetite, pain, frequent urination, increased thirst, constipation, nausea, and vomiting.

Symptoms may be classified by the affected body part:

Calcium plays a major role in the normal functioning of the central nervous system (the brain and spinal cord). Symptoms of hypercalcemia may include weakness, loss of reflexes in the muscles, and decreased stamina. Patients with central nervous system symptoms may have changes in personality, difficulty thinking or speaking clearly, disorientation, or hallucinations. Eventually, coma may result. Headaches can also occur, which can be made worse by vomiting and dehydration.

Hypercalcemia affects normal heart rhythms and increases sensitivity to some heart medications (such as digoxin). As calcium levels increase, irregular heartbeats may develop, and may lead to a heart attack.

Increased stomach acid often is produced with hypercalcemia and may intensify loss of appetite, nausea, and vomiting. Constipation may result from the dehydration associated with hypercalcemia.

Hypercalcemia causes the kidneys to not function correctly, leading to the production of large volumes of urine. The large amount of urine combined with less liquid intake leads to symptoms of dehydration, including thirst, dry mouth, little or no sweating, and concentrated urine. Patients with myeloma often have kidney problems due to hypercalcemia. Kidney stones may result from long-term hypercalcemia.

Hypercalcemia of cancer can result from bone metastases or bone loss, and may contribute to broken bones, bone disfigurement, and pain.

Assessment

Laboratory assessment

A blood test is done to check the level of calcium. Other blood tests may be done to check kidney function.

Patients with high calcium levels should be examined for the following:

• Symptoms:
  • Nerves and muscles (muscle strength, muscle tone, reflexes, tiredness, indifference, depression, confusion, restlessness).
  • Heart (high blood pressure, heart changes, irregular heartbeat, digitalis poisoning).
  • Kidneys (production of too much urine, night-time urinating, sugar in the urine, excess thirst).
  • Gastrointestinal (loss of appetite, nausea, abdominal pain, constipation, abdominal bloating).
  • Other (muscle and bone pain, itching).
• History:
  • How fast did the symptoms appear?
  • Is there x-ray evidence of primary or metastatic bone disease?
  • Has the patient been taking tamoxifen, estrogen, or androgens?
  • Is the patient taking digoxin?
  • Is the patient receiving calcium in intravenous fluids?
  • Is the patient receiving thiazide diuretics, vitamins A or D, or lithium?
  • Is there another disease present that could cause dehydration or lack of movement?
  • Are there effective treatments for the patient's cancer?

The decision to treat hypercalcemia depends on the treatment goals determined by the patient, caregivers, and the physician. The natural course of untreated hypercalcemia progresses to loss of consciousness and coma. This may be preferred by some patients at the end of life who have unrelieved suffering and/or untreatable symptoms.

Treatment

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.

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Changes to This Summary (12/08/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ³. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁶. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

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 type of hormone that promotes the development and maintenance of male sex characteristics.

An abnormal loss of the appetite for food. Anorexia can be caused by cancer, AIDS, a mental disorder (i.e., anorexia nervosa), or other diseases.

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 swelling or feeling of fullness in the abdomen. Bloating is usually the result of gas in the intestines and can be caused by many things, including overeating, lactose intolerance, and constipation. Bloating can also be a side effect of cancer or cancer treatment.

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.

A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.

Cancer that has spread from the original (primary) tumor to the bone.

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

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.

A case in which cancer cells are found in the body, but the place where the cells first started growing (the origin or primary site) cannot be determined. Also called carcinoma of unknown primary and CUP.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

The brain and spinal cord. Also called CNS.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

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.

A condition in which a patient is in a state of deep sleep and cannot be awakened. A coma may be caused by many things, including trauma, drugs, toxins, or certain diseases.

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 identifying a disease, such as cancer, from its signs and symptoms.

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

The things a person eats and drinks.

A substance used to make drugs that are used to treat several heart conditions, including congestive heart failure. Digitalis is made from the dried leaves of Digitalis purpurea (common foxglove) plants. It is a type of cardiac glycoside.

A drug used to treat irregular heartbeat and some types of heart failure. It is also being studied in the treatment of some types of cancer. Digoxin helps the heart work normally by controlling the amount of calcium that goes into the heart muscle. It also may kill cancer cells and make them more sensitive to anticancer drugs. It is a type of cardiac glycoside. Also called Lanoxin.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

A mental state marked by confusion about time, place, or who one is.

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 type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

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).

To get rid of waste material from the blood, tissues, or organs by a normal discharge (such as sweat, urine, or stool).

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

The material in a bowel movement. Feces is made up of food that was not digested, bacteria, mucus, and cells from the intestines. Also called stool.

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).

Refers to the stomach and intestines. Also called GI.

A sight, sound, smell, taste, or touch that a person believes to be real but is not real. Hallucinations can be caused by nervous system disease, certain drugs, or mental disorders.

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

A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called hypertension.

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

Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

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 starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

A soft metal. Lithium salts are used to treat certain mental disorders, especially bipolar (manic depressive) disorder. Lithium salts include lithium carbonate and lithium citrate.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

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.

Having to do with metastasis, which is the spread of cancer from one part of the body to another.

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

Cancer that arises in plasma cells, a type of white blood cell.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

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.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

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.

Medical doctor.

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.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.

The energy and strength to endure physical activity, stress, or illness over time.

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

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

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.

A drug used to treat certain types of breast cancer in women and men. It is also used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and in women who are at a high risk of developing breast cancer. Tamoxifen is also being studied in the treatment of other types of cancer. It blocks the effects of the hormone estrogen in the breast. Tamoxifen is a type of antiestrogen. Also called tamoxifen citrate.

Disease that cannot be cured and will cause death.

Treatment.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

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.

A nutrient that the body needs in small amounts to function and stay healthy. Vitamin A helps in vision, bone growth, reproduction, growth of epithelium (cells that line the internal and external surfaces of the body), and fighting infections. It is fat-soluble (can dissolve in fats and oils). Vitamin A is found in liver, egg yolks, and whole milk dairy products from animals and in fish oils. It can also be made in the body from a substance found in some fruits and vegetables, such as cantaloupes, carrots, spinach, and sweet potatoes. Vitamin A is being studied in the prevention and treatment of some types of cancer. Also called retinol.

A nutrient that the body needs in small amounts to function and stay healthy. Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is found in fatty fish, egg yolks, and dairy products. Skin exposed to sunshine can also make vitamin D. Not enough vitamin D can cause a bone disease called rickets. It is being studied in the prevention and treatment of some types of cancer. Also called cholecalciferol.

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

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.