Hipercalcemia en pacientes con cáncer

La hipercalcemia, es decir, un nivel elevado de calcio en la sangre, es una complicación común y grave que afecta al 10 a 15 por ciento de las personas con cáncer avanzado. Se diagnostica mediante un simple análisis de sangre y se controla con frecuencia en personas que viven con cáncer.

Un nivel elevado de calcio es más común en personas con cáncer de pulmón o de mama, pero puede ocurrir con cualquier tipo de cáncer, especialmente cánceres como los linfomas y el mieloma múltiple .

Los síntomas

El conocimiento de los síntomas de calcio elevado puede ayudarlo a comunicarse con su médico antes de que se convierta en un problema grave. Muchos de los síntomas son vagos y pueden presentarse con otras afecciones que no sean hipercalcemia, especialmente algunos tratamientos para el cáncer, por lo que es importante estar al tanto de ellos. Algunos de estos incluyen:

  • Náusea
  • Vómito
  • Pérdida de apetito
  • Dolor abdominal
  • Aumento de la sed
  • Disminución de la micción
  • Debilidad
  • Estreñimiento
  • Dolor muscular y articular
  • Cálculos renales
  • Confusión, alucinaciones o cambios de personalidad.
  • Frecuencia cardiaca irregular
  • Cuando es grave, coma y muerte.

Causas

There are several causes of a high calcium level in people with cancer. Some of these include:

  • Release of calcium from cancer growing in bones (such as multiple myeloma) or spread of cancer to bones
  • Secretion of hormone-like substances by cancer cells that increase the calcium level (in paraneoplastic syndrome for example.) These substances act like parathyroid hormone (a hormone secreted by the parathyroid glands which sit behind the thyroid gland) and stimulate the release of calcium from the bones 
  • Kidney dysfunction in which the kidneys do not remove calcium from the blood as they are meant to do
  • Dehydration

Treatment

The treatment of hypercalcemia will vary depending upon how elevated your calcium is, as well as the cause. In addition to treating the tumor (which may decrease the level) other treatments include:

  • IV fluids
  • Steroids
  • Medications to lower the calcium level such as bisphosphonates. Calcitonin, gallium nitrate, or mithramycin may sometimes be used. New therapies are being studied (such as denosumab) that appear promising for treatment in the future
  • Dialysis if hypercalcemia is very severe

Prognosis

Hypercalcemia can be a very serious complication of cancer (especially advanced cancer) but can be very treatable when caught early. In general, hypercalcemia is associated with a poorer prognosis overall for someone living with cancer, and specifically, has been found to be associated with a shorter life expectancy in people with lung cancer.

Prevention

Preventing hypercalcemia is the best treatment, and there are a few things you can do to help maintain a normal calcium level. Some of these include:

  • Stay well hydrated, and call your doctor if you are nauseous and unable to keep fluids down.
  • Engage in regular physical activity.
  • Get enough salt in your diet.

While staying well hydrated can help, decreasing the amount of calcium in foods you eat, such as avoiding dairy products, doesn’t help prevent an elevated calcium level.

Caring for Yourself

Hypercalcemia is but one of the complications that may occur with cancer. Taking a moment to learn about the warning signs ahead of time can sometimes less anxiety when you are actually faced with these symptoms. Check out some of the common emergencies which can occur with cancer, and when to call 911.