Hypercalcaemia in Childhood Cancer

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Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Hypercalcemia is when a person has a higher than usual level of calcium in the blood. About 10% – 20% of people with cancer develop hypercalcemia, which can be life-threatening.

Most of the calcium in one’s body is in the bones; around 1% of the body’s calcium is the blood. Calcium is important for many bodily functions including helping with bone formation and muscle, nerve, and brain function.

The body controls the level of calcium in the blood in many ways. Both parathyroid hormone and the kidneys play a role; Parathyroid hormone is released by the parathyroid glands and the kidneys remove excess calcium from the blood.

 

Symptoms

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

Hypercalcemia symptoms often develop slowly and may be similar to the symptoms of cancer or the side effects of cancer treatment. The severity of an individual’s symptoms is not related to the calcium level in the blood; many patients have no symptoms at all.

Individuals with hypercalcemia may experience the following symptoms:

  • Confusion, disorientation, and difficulty thinking
  • Constipation and abdominal pain
  • Depression
  • Fatigue, weakness, and muscle pain
  • Headaches
  • Increased thirst and frequent urination
  • Loss of appetite
  • Nausea and vomiting

Symptoms of severe hypercalcemia may include:

  • Kidney stones – a painful condition in which salt and minerals form solid masses called stones in the kidneys or urinary tract
  • Irregular Heartbeat
  • Heart Attack
  • Loss of Consciousness
  • Coma

It is important to be familiar with the symptoms mentioned above if your child is undergoing any cancer treatments, and as always, speak to your child’s doctor if they exhibit any of these symptoms whatsoever.

 

Causes

Cancer can cause high levels of blood calcium in different ways; Cancers that affect the bone such as Multiple Myeloma or Leukaemia and cancer that has spread to the bone may cause the bone to break down, which releases excess calcium into the blood.

Some tumours produce a protein that acts very similar to parathyroid hormone, which causes the bone to release calcium into the blood. Some cancers can affect the ability of the kidneys to remove excess calcium from the blood.

Dehydration caused by nausea and vomiting makes it difficult for the kidneys to remove calcium from the blood properly. Lack of physical activity can also cause bone to break down, releasing calcium into the blood.

Cancers that may cause hypercalcemia include:

  • Breast Cancer
  • Lung Cancer
  • Multiple Myeloma
  • Lymphoma
  • Leukaemia
  • Kidney cancer
  • Head and Neck Cancers
  • Gastrointestinal Cancers

 

Diagnosis

Your child’s doctor will perform a blood test to check the level of calcium and may also do other blood tests to check kidney function in order to correctly diagnose hypercalcemia.

Once hypercalcemia is diagnosed, your child’s doctor will plan the best way to manage the condition based on its severity.

Mild Hypercalcemia: Patients who have no symptoms receive extra fluids, usually given through a vein. This helps the kidneys remove excess calcium.

Moderate or Severe Hypercalcemia: Doctors manage Moderate or Severe Hypercalcemia in different ways, including:

  • Cancer: Treating the cancer
  • Fluids: Replacing fluids lost through vomiting, frequent urination, or other reasons
  • Medication: Giving medicines to help stop the breakdown of bone
  • Steroids: Giving steroids to individuals with specific cancers, such as lymphoma. Steroids help decrease the breakdown of bone and increase calcium uptake from food. However, steroids may increase the risk of osteoporosis and the breakdown of bone in some situations.
  • Dialysis: Using dialysis for patients with kidney failure. Dialysis is a mechanised filtering process that removes excess waste from the blood.

 

Management/Treatment

Treatment improves symptoms and quality of life, which may make it easier to complete cancer treatment. It is important to understand, however, that unless there is an effective treatment for the cancer itself; hypercalcemia suggests that a patient is approaching the last weeks of life.

Things you can do to help prevent and manage hypercalcemia

In addition to getting your child treatment from your doctor, the following tips can help prevent hypercalcemia or keep it from worsening:

  • Give your child plenty of  fluids to drink
  • Control your child’s nausea and vomiting
  • Encourage your child to walk and be active, which helps prevent bone from breaking down
  • Check with your child’s doctor before giving them any medications, as some medications may make the hypercalcemia worse

 

Note:

In people with cancer, hypercalcemia is not related to having too much calcium in the diet. Reducing calcium intake by eating fewer dairy products and other high-calcium foods will not help to resolve the condition.