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      Hypercalcemia in Colorectal Cancer

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      Canadian Journal of General Internal Medicine
      Dougmar Publishing Group, Inc.

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          Abstract

          Humoral hypercalcemia of malignancy is common in many cancers but is rarely present in colorectal cancers with only 24 documented cases in the literature. In this report, we present a case of a 67-year-old woman complaining of right sided abdominal pain and diarrhea. Imaging showed an obstructing cecal mass and the pathological diagnosis was poorly differentiated adenocarcinoma. After a hemicolectomy, she developed humoral hypercalcemia of malignancy which was treated with intravenous bisphosphonates. She continued to worsen due to her rapid progression of disease and died less than one month after her initial diagnosis. We reviewed the 24 other documented cases to investigate the prognosis of hypercalcemia in colorectal cancers along with reviewing the clinical presentation and management of humoral hypercalcemia of malignancy. Résumé L’hypercalcémie humorale maligne est courante dans de nombreux cas de cancers, mais elle est rare dans les cancers colorectaux; la documentation recense 24 cas seulement. Dans le présent article, nous décrivons le cas d’une femme de 67 ans se plaignant de douleurs abdominales du côté droit et de diarrhée. Un examen d’imagerie indiqua la présence d’une masse caecale obstructive dont le diagnostic pathologique s’est avéré être celui d’un adénocarcinome peu différencié. À la suite d’une hémicolectomie, la patiente a développé une hypercalcémie humorale maligne qui a été traitée à l’aide de bisphosphonates intraveineux. Son état a continué de se détériorer en raison de la progression rapide de la maladie et la patiente est décédée moins d’un mois après le diagnostic initial. Nous passons en revue les 24 cas documentés pour analyser les pronostics d’hypercalcémie dans les cas de cancers colorectaux, tout en examinant le tableau clinique et la prise en charge de l’hypercalcémie humorale maligne.    

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          Most cited references17

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          Clinical practice. Hypercalcemia associated with cancer.

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            Hypercalcaemia of malignancy and basic research on mechanisms responsible for osteolytic and osteoblastic metastasis to bone.

            Calcium homeostasis is a tightly regulated process involving the co-ordinated efforts of the skeleton, kidney, parathyroid glands and intestine. Neoplasms can alter this homeostasis indirectly through the production of endocrine factors resulting in humoral hypercalcaemia of malignancy. Relatively common with breast and lung cancer, this paraneoplastic condition is most often due to tumour production of parathyroid hormone-related protein and ensuing increased osteoclastic bone resorption. Although control of hypercalcaemia is generally successful, the development of this complication is associated with a poor prognosis. The metastasis of tumour cells to bone represents another skeletal complication of malignancy. As explained in the 'seed and soil' hypothesis, bone represents a fertile ground for cancer cells to flourish. The molecular mechanisms of this mutually beneficial relationship between bone and cancer cells are beginning to be understood. In the case of osteolytic bone disease, tumour-produced parathyroid hormone-related protein stimulates osteoclasts that in turn secrete tumour-activating transforming growth factor-beta that further stimulates local cancer cells. This 'vicious cycle' of bone metastases represents reciprocal bone/cancer cellular signals that likely modulate osteoblastic bone metastatic lesions as well. The development of targeted therapies to either block initial cancer cell chemotaxis, invasion and adhesion or to break the 'vicious cycle' is dependent on a more complete understanding of bone metastases. Although bisphosphonates delay progression of skeletal metastases, it is clear that more effective therapies are needed. Cancer-associated bone morbidity remains a major public health problem, and to improve therapy and prevention it is important to understand the pathophysiology of the effects of cancer on bone. This review will detail scientific advances regarding this area.
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              Bisphosphonates: Mechanisms of Action

              H Fleisch (1998)
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                Author and article information

                Journal
                Canadian Journal of General Internal Medicine
                Can Journ Gen Int Med
                Dougmar Publishing Group, Inc.
                2369-1778
                1911-1606
                January 02 2018
                January 02 2018
                : 12
                : 4
                Article
                10.22374/cjgim.v12i4.200
                c5efccf2-7034-44b2-80aa-1aaf36a0f016
                © 2018

                Copyright of articles published in all DPG titles is retained by the author. The author grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any non-commercial third party the rights to use the article freely provided original author(s) and citation details are cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/


                General medicine,Geriatric medicine,Neurology,Internal medicine
                General medicine, Geriatric medicine, Neurology, Internal medicine

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