Breast cancer hypercalcemia with

Warning associated with the administration of estrogen include an increased risk of endometrial cancer, gallbladder disease, hypertension, hepatic adenoma (a benign tumor of the liver), cardiovascular disease, increased risk of thromboembolic disease and hypercalcemia in those with breast cancer and bone metastases. 

The estrogens are used cautiously in patients with gallbladder disease, hypercalcemia (may lead to severe hypercalcemia in patients with breast cancer and bone metastasis), cardiovascular disease, and liver impairment. 

Tamoxifen can be used in both premenopausal and postmenopausal women with metastatic breast cancer who have tumors that are hormone-receptor-positive. The toxicities of tamoxifen are described in the section on adjuvant endocrine therapy. The only additional toxicity that one might expect to find in the setting of metastatic breast cancer (specifically bone metastases) is a tumor flare or hypercalcemia, which occurs in approximately 5% of patients following the initiation of any SERM therapy and is not an indication to discontinue SERM therapy. It is generally accepted that this is a positive indication that the patient will respond to endocrine therapy. 

Hypercalcemia occurs in 10% to 30% of patients with cancer during the course of their disease. The most common tumor types associated with hypercalcemia are breast cancer squamous cell carcinomas of the head, neck, and lung and renal cancer. 

Edema, nausea, insomnia, oligospermia, priapism, male pattern of baldness, bladder irritability, hypercalcemia in immobilized patients orthose with breast cancer, hypercholesterolemia Rare... 

A 46-year-old woman with low back pain and osteoporosis took salmon calcitonin subcutaneously 100 U/ day and calcium carbonate orally 1.5 g/day for 7 days before developing nausea and facial flushing (13). Calcitonin was continued for a further 8 days and then stopped. The next day she developed intermittent generalized convulsions. She was subsequently found to have breast cancer with skeletal metastases and hypercalcemia (3.9 mmol/1) without a reduced... 

Pamidronate, a second-generation bisphosphonate, is 100-fold more potent than etidronate (Fig. 35.7) (6). It has been approved for the treatment of hypercalcemia of malignancy, for Paget s disease, and for osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma. When used to treat bone metastases, pamidronate decreases osteoclast recruitment, decreases osteoclast activity and increases osteoclast apoptosis (53). Erosive esophagitis has been reported with the use of pamidronate sodium. 

Hypercalcemia of malignancy is a common occurrence in solid tumors of the lung and breast as well as multiple myeloma and adult T-cell lymphoma/leukemia (26). The hypercalcemia associated with breast cancer is usually seen in late stages of the disease in patients with extensive bone metastases. In squamous cell carcinoma of the lung or kidney, however, hypercalcemia is not correlated with disease stage and is not necessarily associated with bone metastases. The hypercalcemia results from increased bone resorption, decreased bone formation and increased renal tubular calcium reabsorption. These findings suggest that some tumors may secrete humoral factors with PTH-like actions. 

Calciphylaxis is a rare life-threatening disorder characterized hy progressive vascular calcification and ischemic tissue loss in patients with end-stage renal disease (Wood et al. 1997 Hafner et al. 1998 Karpman et al. 2003 Guvel et al. 2004). The pathogenesis is poorly understood it is likely the result of a multiplicity of co-morbid factors or events. Disorders that are most often implicated include chronic renal failure, hypercalcemia, hyperphosphatemia, an elevated calcium-phosphate product and secondary hyperparathyroidism. Very rare cases of calciphylaxis not associated with chronic renal failure have been reported with breast cancer, hyperparathyroidism and alcoholic cirrhosis. 

Aredia, pamidronate disodium (APD), is a bone-resorption inhibitor used to treat hypercalcemia associated with malignancy and osteolytic bone lesions associated with multiple myeloma, metastatic breast cancer, and moderate to severe Paget s disease of bone. Aredia, a member of the group of chemical compounds known as bisphosphonates, is an analog of pyrophosphate. Pamidronate disodium is designated chemically as phosphonic acid (3-amino-l-hydroxypropylidene) bis-, disodium salt, pentahydrate, (APD). 

In hospitalized patients, hypercalcemia of malignancy is the major cause of hypercalcemia (26,, , 54). In two separate studies, 9X of all cancer patients had hypercalcemia of malignancy (. 56). Hypercalcemia of malignancy is most common in solid tumors such as carcinomas of the lung, breast, kidney, pancreas and ovary, but also occurs with multiple myeloma and adult T-cell lymphoma/ leukemia. It has been estimated that there is approximately an equal distribution between humoral factors and metastatic bone tumors for causing hypercalcemia of malignancy (26,57,58). 

---