Managing high calcium
This page has information about treating high calcium levels (hypercalcaemia) in people with cancer. There is information about
If you have any of the symptoms of hypercalcaemia your doctor will want to examine you. They will also measure your calcium levels with a blood test. You may also have other tests and investigations to see how well your kidneys are working. If the test results show that you have high levels of calcium in your blood, you will need treatment.
Before your doctor can manage your hypercalcaemia they will need to ask you a lot of questions about the history of your illness and your symptoms. It may seem like a lot to deal with if you are not feeling very well at the time. You probably just want your doctor to give you something to relieve your symptoms and leave you alone. But it is very important that your doctor takes the time to assess all aspects of your condition so that you get the right diagnosis and treatment.
If you are in too much pain or feeling too tired or sick, and you really do not feel that you can answer questions, then your family and friends may be able to help. If you have very severe hypercalcaemia it is unlikely that you will be able to answer the questions. Your doctor will rely on information from the people close to you and your test results to decide on your treatment.
Your doctor may ask
- Do you feel sick? If so, when and how often?
- Have you been vomiting? How often?
- Has your appetite changed? Are you eating less?
- Do you have any pain? If so, where and how often?
- Do you feel more tired than usual?
- Do you feel muddled or confused?
- Are you passing large amounts of urine?
- Do you feel thirsty?
- How long have you been having symptoms?
- What medicines are you taking?
Your doctor will use your answers and test results to decide whether high calcium levels are causing your symptoms or whether they could be due to something else.
If you have a type of cancer that is likely to cause hypercalcaemia then you may be able to help prevent it or at least make sure your doctor picks it up early. Recognising the symptoms of hypercalcaemia is very important so that you can ask your doctor for help as soon as possible. Drinking plenty of fluids and staying as active as possible may help to prevent hypercalcaemia.
The main aims of hypercalcaemia treatment are to lower the blood calcium levels and to relieve the symptoms. You will need treatment from your specialist. You may have to spend a day or two in hospital to get your calcium levels down. The main treatments for high calcium levels are
Fluids through a drip help flush the extra calcium out of your system. Drinking plenty of fluid will help too, if you can manage it.
Bisphosphonates (bis-fos-fon-ates) are very effective drugs for helping to get your calcium levels down. You have to have some of these drugs through a drip into a vein, but others come as tablets. Which you need depends on how high your calcium levels are.
As well as getting calcium levels down, bisphosphonates can help to reduce pain from bone secondaries and help to stop damaged bones breaking. You may have bisphosphonate tablets to take home to stop the calcium building up in your blood again. There is more information about bisphosphonates and their side effects in the cancer treatment section.
Bisphosphonates can sometimes make your calcium level go too low (hypocalcaemia). This should be picked up by blood tests, but also causes symptoms such as changes in sensation – for example, tingling or burning in the lips or tongue.
Calcitonin is another drug that you may have to help stop the breakdown of bone. You have this drug as an injection. You may also have drugs to help relieve hypercalcaemia symptoms, such as sickness, constipation, pain or confusion.
Denosumab is a monoclonal antibody, which is a type of biological therapy. The national bodies that decide which treatments should be available within the NHS in the UK say denosumab should be available for people with secondary bone cancer who would otherwise have bisphophonate as a treatment. They say there is not enough evidence to recommend it for cancers that start in the prostate gland and have spread to the bone as the research so far shows that other treatments work equally as well. There is more about denosumab in the cancer drugs section.
The type of treatment you have will depend on how high your calcium levels are and how severe your symptoms are. If you have moderate to severe hypercalcaemia, or severe symptoms, your doctor will need to treat it urgently with fluids and bisphosphonate drugs. If it is mild hypercalcaemia, you will still need treatment but less urgently. If you are able to drink plenty of fluids, you may just need the bisphosphonate treatment.
Treatment relieves some symptoms more quickly than others. For example, sickness, constipation and thirst are much easier to relieve than tiredness and loss of appetite. If your cancer is very advanced and you are in the terminal stage, it will probably not be possible to control your hypercalcaemia permanently. But your doctors will do all they can to help make you as comfortable as possible.
Once your blood calcium levels go back to normal, your doctor will want to keep a close eye on you. You will need to have regular blood and urine tests to make sure the treatment is still working.
If at any time you feel the symptoms of hypercalcaemia are coming back, it is very important that you see your doctor as soon as possible. Even if something else is causing your symptoms it is better to see your doctor to find out for sure.
You may worry about eating foods that contain calcium if you have hypercalcaemia or think you may be at risk of it. But cutting down on these foods will not help hypercalcaemia that is caused by cancer. It will not make any difference to your calcium levels. Do talk to your doctor or nurse if you are concerned about your diet. And make sure you check with your doctor before taking any vitamin or mineral supplements.
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