A hipercalcemia nas malignidades: aspectos clínicos, diagnósticos e terapêuticos

Abstract

Hypercalcemia associated with malignancies is reported in up to 20 to 30% of patients with cancer during the course of the disease, and points to a poor prognosis. Symptoms related to the central nervous system, as progressive mental impairment, stupor and coma, predominate. Alterations in kidney function (water-concentrating defect leading to polyuria) and gastrointestinal tract (anorexia, nausea, vomiting) corroborate to dehydration and a further increase in serum calcium. Cancer-induced hypercalcemia may be classified as: 1) local osteolytic hypercalcemia (LOH), due to marked increase in osteoclastic bone resorption in areas surrounding the malignant cells within the marrow space; 2) humoral hypercalcemia of malignancy, caused by the secretion of parathyroid hormone-related protein (PTHrP) by the malignant tumor; 3) ectopic hyperparathyroidism; 4) 1,25(OH)2 D-secreting tumors. Adequate control of hypercalcemia is necessary to give the patient time to respond to anti-cancer therapy. Volume expansion with saline will correct dehydration, improve glomerular filtration and increase urinary calcium excretion, which may be further stimulated by loop diuretics. Intravenous bisphosphonates are the most effective agents to control hypercalcemia, as they block osteoclastic osteolysis and also have antitumoral effects, decreasing bone metastases. New approaches to control the skeletal manifestations of malignancies are anti-PTHrP and anti-RANKL antibodies, osteoprotegerin, and also proteasome inhibitors in the case of multiple myeloma.

Spinal Metastasis: Diagnosis, Treatment and Prognosis - Integrative Review From 2012 to 2017

“…In mechanical pain, it recommended to stabilize the spine as conventional or minimally invasive arthrodesis, vertebroplasty, kyphoplasty, stereotactic radiosurgery or surgery traditional as vertebrectom. 7,29,[72][73][74][75][76][77][78][79][80][81][82][83][84] • Fracture: Sometimes fractures are the first symptom associated with pain. The thoracolumbar region is the most frequent site of spinal fractures.…”

“…Other treatments include phosphate repositioning, administration of glucocorticoids to reduce intestinal absorption, and antiresorptive medications, such as bisphosphonates like zoledronic acid. 73,[82][83][84][85] The diagnosis should also be conducted using imaging exams, such as X-rays, magnetic fields, or radioactive substances. The X-ray can show signs of dissemination of the disease to the bones in osteolytic or lytic metastases, due to destruction of the bone.…”

“…In addition to these, there are computed tomography and/or magnetic resonance with and without contrast, positron emission tomography or PET scan, which enables detection of whether the cancer has spread to the lymph nodes or to other body structures and organs, and also needle or incisional biopsy, and laboratory tests of tumor markers, calcium and alkaline phosphatase, and N-telopeptide (urine). [82][83][84][85][86] The predominance of articles in the literature on minimally invasive surgical procedures in the treatment of spinal metastases agrees Evaluation of the interobserver reproducibility of a new scale for orientation of therapeutic conduct in spinal metastases: SINS score (Spine Instability Neoplastic Score) 25 Effectiveness of surgical intervention in the quality of life and survival of patients with metastatic lesions of the spine 22 Tokuhashi Score and other prognostic factors in 260 patients with surgery for spinal metastases 31 Prognostic factors associated with the survival of patients with symptomatic bone metastases: retrospective cohort study of 1,043 patients 27 Prognostic factors in patients with symptomatic spinal metastases and normal neurological function 32 Score evaluation in decision-making in spinal metastases 30 23 Current paradigms for metastatic medullary disease: an evidence-based review 26 Spinal metastasis in thyroid cancer 28 Patients with spinal metastases submitted to neurology decompression and stabilization 29 Prognostic factors in patients with symptomatic spinal metastases and normal neurological function 32 Results and toxicity for image-guided hypofractionated stereotactic radiosurgery for metastatic spinal sarcomas 35…”

Mieloma múltiplo: verificação do conhecimento da doença em médicos que atuam na atenção primária à saúde

“…O esqueleto é o terceiro sítio mais frequente de metástase, sendo as neoplasias de próstata, mama, pulmão e rins as que mais comumente levam à metástase óssea. 20 As metástases desses tumores são osteolíticas e osteoblásticas e é comum ambos os tipos coexistirem no mesmo paciente. No câncer de próstata, aproximadamente 80% das metástases ósseas são osteoblásticas.…”

L’hypercalcémie associée au cancer

“…La présence d'une hypercalcémie chez un patient cancéreux est un signe de très mauvais pronostic. Physiopathologie L'HM peut être divisée en quatre groupes expliquant ses mécanismes physiopathologiques (Tableau 1) [2] :…”