Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020437 (hypercalcemia)
 10,293 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bone metastasis is in 60-84% of a metastatic cancer case. Bone metastasis itself does not cause a pain by all means, but even if bone metastasis contributes to 40% of cancer pain, it is said, and it is an important subject of a cancer pain treatment. Because it is a lot progressive as well as an unbearable pain, bone metastasis becomes cause by the fact that the pain is remarkable and inhibits QOL of the patient. On this account that a treatment of bone metastatic pain merely takes a pain by pharmacotherapy. Preventing pathologic fracture and a complication such as spinal cord compression and a treatment of hypercalcemia are important. In addition, we do surgical treatment and radiation therapy for the fracture that occurred positively and must deal generally.
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PMID:[Symptom with bone metastasis--bone pain, fracture, hypercalcemia]. 1723 19

The present article overviews the role of bisphosphonates for the treatment and prevention of bone metastases and their antiangiogenic effects and antitumoral activity. The skeleton is a frequent and clinically relevant site of metastasis in cancer patients. The major events related to bone metastases include bone pain, bone loss, hypercalcemia, spinal cord compression, and fractures. On the basis of their radiographic features, bone metastases are classified as osteoblastic, osteoclastic, or mixed. The primary goals of treatment of bone metastases are reduction of the risk of pathological fractures and other skeletal-related events, and pain control. Bisphosphonates are used to prevent pathological fractures by inhibition of osteoclasts. Recent studies suggest that bisphosphonates have some direct antitumoral activity, mainly mediated through the blockade of angiogenic pathways. Further clinical studies are needed to determine the optimal treatment duration, timing and schedule of bisphosphonates, assess their role as adjuvant therapy for the prevention of bone metastases, and establish their antiangiogenic activity in association with standard cytotoxic and hormonal drugs for treatment of patients with advanced disease.
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PMID:Clinical usefulness of bisphosphonates in oncology: treatment of bone metastases, antitumoral activity and effect on bone resorption markers. 1739 58

Care of patients with cancer can be enhanced by continued involvement of the primary care physician. The physician's role may include informing the patient of the diagnosis, helping with decisions about treatment, providing psychological support, treating intercurrent disease, continuing patient-appropriate preventive care, and recognizing and managing or comanaging complications of cancer and cancer therapies. Adverse effects of therapy and cancer-related symptoms include nausea, febrile neutropenia, pain, fatigue, depression, and emotional distress. 5-Hydroxytryptamine antagonists are effective in controlling acute nausea associated with chemotherapy. Febrile neutropenia requires systematic evaluation and early empiric antibiotics while awaiting culture results. Cancer-related pain, depression, and fatigue often are underdiagnosed and undertreated. Use of brief screening tools for assessing fatigue and emotional distress can improve management of these symptoms. Exercise prescription, activity management, and psychosocial interventions are useful in treating cancer-related fatigue. The physician must be alert for signs and symptoms of cancer-related emergencies like spinal cord compression, hypercalcemia, tumor lysis syndrome, pericardial tamponade, and superior vena cava syndrome.
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PMID:Primary care of the patient with cancer. 1747 4

Solid tumors frequently metastasize to bone. This results in debilitating skeletal complications such as intractable bone pain, pathologic fractures, spinal cord compression, and hypercalcemia. Patients frequently require palliative radiation therapy or orthopedic surgery. Bisphosphonates have been shown to delay the incidence and decrease the frequency of skeletal-related events. Zoledronic acid is the only bisphosphonate that has provided benefits for patients with bone metastases secondary to a broad range of solid tumors. Among patients with metastatic breast or prostate cancer, zoledronic acid has demonstrated significant reductions in pain and skeletal morbidity compared with placebo. Zoledronic acid has also shown significant reductions in skeletal morbidity in patients with lung cancer or other solid tumors compared with placebo. Zoledronic acid is generally well tolerated. Flu-like symptoms which are manageable with standard treatment can occur. Renal monitoring is recommended, with dose reductions for patients with renal dysfunction. Osteonecrosis has been reported in patients receiving bisphosphonates and might be avoidable with appropriate dental care.
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PMID:Efficacy and safety of intravenous bisphosphonates in patients with bone metastases caused by metastatic breast cancer. 1768 49

Multiple myeloma, the second most common haematopoietic cancer, represents a collection of plasma-cell neoplasms that invariably become fatal when self-renewing myeloma cells begin unrestrained proliferation. The major clinical manifestation of multiple myeloma is related to loss of bone through osteolysis. The bone disease can lead to pathologic fractures, spinal cord compression, hypercalcemia, and pain. It is also a major cause of morbidity and mortality in these patients. These patients frequently require radiation therapy, surgery and analgesic medications. Bisphosphonates are specific inhibitors of osteoclastic activity, and are currently used to prevent bone complications and to treat malignant hypercalcemia in patients with multiple myeloma, or bone metastases from breast and prostate cancers. Recent published reports have documented a possible link between treatment with intravenous bisphosphonates and osteonecrosis of the jaw. Bisphosphonates have been demonstrated to alter the normal bone microenvironment and appear to have direct effects on tumours as well. These changes may contribute to the development of osteonecrosis of the jaw in these patients, particularly after tooth extractions or other invasive dental procedures. Osteonecrosis of the mandible has been reported in 3 patients from Centro Hospitalar de Vila Nova de Gaia (CHVNG) with multiple myeloma treated for over 18 to 48 months with intravenous bisphosphonate zoledronate. It has been postulated that bisphosphonates may cause oral avascular bone necrosis due to antiangiogenic effect leading to disruption of osteoclast-mediated bone resorption. Although this report serves to alert clinicians about the potential complication of bone necrosis in patients receiving bisphosphonates therapy, many questions remain concerning the underlying pathogenesis of this process. In these 3 described clinical cases, surgical debridment without flap elevation, intensive antibiotherapy and zolendronate treatment arrest made possible the partial recovery of the patients. We purpose this type of clinical approach in patients suffering from multiple myeloma and bone osteonecrosis induced by bisphosphonate treatment. Research to determine the mechanism of this dental phenomenon is needed to fully validate and substantiated the possible link between bisphosphonates treatment of multiple myeloma or other cancer diseases with avascular osteonecrosis of the jaws. Until then, clinicians involved in the care of patients at risk should consider this possible complication.
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PMID:Maxilla osseus sequestre and oral exposure: effects of the treatment of multiple myeloma with bisphosphonates. 1786 26

Osteoclastic bone resorption is a critical component of skeletal complications of malignancy including fracture, bone pain, hypercalcemia, and spinal cord compression. Three proteins, RANKL, RANK, and OPG have been recently identified as key determinants of osteoclastogenesis and the regulation of bone resorption. Both RANKL and OPG can be aberrantly regulated in the cancer setting and function as important gatekeepers of tumor-induced osteolytic bone disease. RANKL-induced osteoclastogenesis not only mediates osteolytic bone disease, but also contributes to the pathogenesis of osteoblastic bone disease resulting from tumors. In addition, an important role was recently described for bone marrow derived RANKL to mediate the bone-specific tropism of RANK-expressing tumor cells. This manuscript will review how RANKL contributes to skeletal complications of cancer and the development of targeted, mechanism-based drugs that inhibit RANKL.
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PMID:RANK ligand as a therapeutic target for bone metastases and multiple myeloma. 1796 29

Multiple myeloma is a tumor of terminally differentiated plasma cells that home to and expand in the bone marrow. It is the second most common hematologic malignancy, with approximately 16,000 new cases per year, and accounts for an estimated 11,000 deaths in the USA. It is the most common cancer to metastasize to bone, with up to 90% of patients developing bone lesions. The bone lesions are purely osteolytic in nature, and up to 60% of patients develop a pathologic fracture over the course of their disease. Bone disease is a hallmark of multiple myeloma, and the bone disease differs from other bone metastasis caused by other tumors. Although both myeloma and other osteolytic metastasis induce increased osteoclastic bone resorption, in contrast to other tumors, osteoblast activity in myeloma is either severely decreased or absent. The basis for this severe imbalance between increased osteoclastic bone resorption and decreased bone formation resulting from suppressed osteoblastic activity has been a topic of extensive investigation during the last several years. The clinical consequences of this extensive accelerated and imbalanced bone destruction process include bone pain, pathologic fractures, hypercalcemia and spinal cord compression syndromes, which can be devastating for patients and significantly impact overall quality of life and expected survival. In this chapter, we will discuss the pathophysiology underlying bone disease in myeloma. This results from the uncoupling of bone remodeling and is characterized by markedly increased activity of osteoclasts and profound decreased activity of osteoblasts. In addition, we also review the emerging data on novel targeted therapies aimed at ameliorating myeloma bone disease.
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PMID:Pathophysiology of myeloma bone disease. 1807 Jul 9

The knowledge of most oncologic emergencies is crucial in daily practice. Treatment options for the superior vena cava syndrome include chemotherapy, radiation, and intravenous stenting. Hypercalcemia due to malignancy is treated with aggressive rehydration and intravenous bisphosphonates. Febrile neutropenia is a hematologic emergency that usually requires inpatient therapy with broad-spectrum antibiotics. Epidural spinal cord compression must be recognized early and can be treated with dexamethason, radiation, or surgery.
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PMID:[Medical emergencies in oncology: from case reports to recommendations]. 1855 20

Bone metastases are common in patients with advanced-stage cancer; they can lead to skeletal complications (ie, pathologic fractures, spinal cord compression, tumor-induced hypercalcemia, and severe bone pain) that often require orthopedic surgery or palliative radiation therapy and negatively affect quality of life. The primary role of bisphosphonates for the management of bone metastases in patients with advanced-stage cancer is the prevention of these painful skeletal complications. In placebo-controlled trials, a number of bisphosphonates, including oral clodronate, oral and intravenous (I.V.) ibandronate, I.V. pamidronate, and I.V. zoledronic acid, have been shown to significantly reduce skeletal complications in patients with bone metastases from breast cancer. Furthermore, zoledronic acid provided benefit compared with pamidronate in patients with bone metastases from breast cancer in a large, comparative trial. Zoledronic acid also provided long-term benefits in randomized placebo-controlled trials in patients with bone metastases from prostate cancer, lung cancer, and other solid tumors, whereas other bisphosphonates that have been investigated have failed to demonstrate objective long-term benefits in placebo-controlled trials. In addition, although systemic analgesics and radiation therapy are primary treatments for the management of bone pain, bisphosphonates can also play an important secondary role in reducing bone pain associated with skeletal metastases. Notably, several economic analyses of bisphosphonate therapy have demonstrated that these agents are cost-effective by reducing health-care costs associated with skeletal complications and providing clinically significant quality of life benefits to patients with malignant bone disease.
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PMID:Role of bisphosphonates for the management of skeletal complications and bone pain from skeletal metastases. 1863 88

Bone is the most common site of metastases in patients with advanced breast cancer. In these patients, the primary aim of therapy is to prevent and delay the occurrence of skeletal-related events (SREs), which can be defined as follows: (1) pain requiring radiation or surgical intervention, (2) spinal cord compression, (3) pathologic fracture, or (4) hypercalcemia. Unfortunately, determining which patients are at highest risk for an SRE is difficult with current imaging techniques. In contrast, the urinary biomarker of bone resorption, collagen N-telopeptide, is under intensive study after repeat validation as a rapid and reliable predictor of SREs as well as prognosis and survival. Herein, we review this new role of collagen N-telopeptide as a predictor of bone involvement and response to treatment, and of the palliative benefit of bisphosphonate therapy in patients with metastatic breast cancer.
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PMID:Urinary N-telopeptide is a rapid predictor of response to and palliative benefit from bisphosphonate therapy in patients with metastatic breast cancer. 1863 15


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