Hypercalcemia is associated with several cancers, most commonly breast, lung, lymphoma, and multiple myeloma. Hypercalcemia in the setting of advanced cancer may be caused by release of calcium due to bone metastases, solid tumor release of PTHrP (parathyroid hormone-related protein), or tumor production of calcitriol leading to increased intestinal calcium resorption. Hypercalcemia in cancer patients is indicative of widespread disease and is associated with a poor prognosis for long-term survival.
Symptoms of elevated serum calcium levels include weakness, fatigue, nausea, and mental status changes.
If treating hypercalcemia is in keeping with the patient’s palliative care goals, serum calcium levels may be lowered with hydration, bisphosphonates, and calcitonin.