Oncology

Question 1

Mechanisms of hypercalcemia in Cancer patients

Answer 1

Vitamin D excess
Direct osteolysis of skeletal masses
Paraneoplastic (PTHrP, ectopic PTH)

Question 2

Malignancies causing Ectopic PTH secretion

Answer 2

Ovarian
Lung
Pancreatic
Thyroid PAPILLARY
Rhabdomyosarcoma
Neuroectodermal Ca

Question 3

Malignancies causing Vitamin D excess

Answer 3

ovarian dysgerminomas
Lymphoma

Question 4

Malignancies causing hypercalcemia secondary to Osteolysis

Answer 4

Multiple myeloma
Lymphoma
Leukemia
Breast Cancer

Question 5

Malignancies causing humeral hypercalcemia (PTHrP)

Answer 5

Squamous cell carcinoma
Renal carcinomas
Bladder carcinomas
Breast cancer
Ovarian Carcinoma
Non-Hodgkins
CML
Leukaemia
Lymphoma

Question 6

management of hypercalcemia

Answer 6

IVF 250-500cc/hr with goal UO 100-200cc/hr
+/- Lasix
Bisphosphonates (Zolendronic>Pamidronate) Vs.Denosumab
Others: calcitonin, steroids, calcimimetics, dialysis
D/C calcium supp, Vit D, thiazides, feeding sources
Dependent on etiology of hypercalcemia
1. Acute treatment to decrease the Calcium with above
2. More long term treatment by targeting the
mechanism/malignancy