Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Curr Opin Support Palliat Care. 2013 Sep;7(3):265-71. doi: 10.1097/SPC.0b013e3283640f5f.
Hypercalcaemia is commonly associated with cancer which is usually advanced and portends a poor prognosis. Hypocalcaemia is more often seen as a complication of therapy aimed at reducing skeletal morbidity rather than an effect of the cancer itself. We present an overview of calcium disorders in malignant disease.
A significant proportion of patients who have a cancer and become hypercalcaemic have an alternative cause for their hypercalcaemia.Evidence for the use of loop diuretics is lacking, and such agents should not be routinely used unless significant volume overload occurs during rehydration. Bisphosphonates are generally established as first-line therapy after volume expansion with saline. As knowledge of bone biology increases, there is interest in the use of the mAb denosumab, for the management refractory hypercalcaemia. Knowledge of the vitamin D status, and supplementation of vitamin D, may reduce the risk of hypocalcaemia when potent antiresorptive medications are being used.
Calcium disorders can be predicted in many tumour types and with antiresorptive therapy. A logical approach to prevention and management of these imbalances should be incorporated into cancer patient care.
高钙血症常与癌症相关，且通常提示癌症已进展至晚期，预后不良。低钙血症更常见于旨在降低骨骼发病率的治疗的并发症，而不是癌症本身的影响。我们对恶性肿瘤中的钙代谢紊乱进行了概述。
相当一部分患有癌症且血钙升高的患者有其他原因导致的高钙血症。尚无使用袢利尿剂的证据，除非在补液过程中发生明显的容量超负荷，否则不应常规使用此类药物。在生理盐水扩容后，双膦酸盐通常作为一线治疗药物。随着对骨生物学认识的提高，人们对使用单克隆抗体地舒单抗治疗难治性高钙血症产生了兴趣。了解维生素 D 状态并补充维生素 D，可能会降低在使用强效抗吸收药物时发生低钙血症的风险。
许多肿瘤类型和抗吸收治疗均可预测钙代谢紊乱。在癌症患者的治疗中应纳入对这些失衡的预防和管理的合理方法。
