Oncology Morning Report
Today's case
involved a 43-year-old man with metastatic melanoma who presented with
generalized weakness and hip pain. He
was admitted with a mild hypercalcemia of 2.8mmol/L. He was hydrated overnight, and his bone pain
will be investigated with imaging studies today.
There were several
valuable learning points, as this patient represents a very common scenario encountered
at this hospital:
-Hypercalcemia of
malignancy can occur for a variety of reasons.
A review from the NEJM is attached with a clinical scenario
-Treatment relies on
intravenous fluids to help correct the metabolic abnormalities associated with
hypercalcemia (diuresis, acute kidney injury) and can also include
bisphosphonate therapy (pamidronate 90mg IV, or zoledonate 4mg IV)
-Cancer patients also
have a higher incidence of primary hyperparathyroidism, so checking an intact
PTH level is important
-We discussed opioids
and the management of cancer-associated pain, and cancer-associated nausea
-We discussed
malignant melanoma and particularly the lack of efficacy of traditional
therapies (alkylating agents and anti-metabolites) with some new effective
therapies on the horizon (BRAF inhibitors, Tyrosine Kinase inhibitors,
immunotherapy)
-We discussed choosing
wisely in terms of the appropriateness of brain imaging in patients with
newly-diagnosed cancer; to review, the only indications are 1) symptoms suggestive
of CNS disease warranting investigation, 2) melanoma and 3) lung cancer of any
type
Further Reading:
Johnson, D. B., & Sosman, J. A. Therapeutic Advances and Treatment Options in Metastatic Melanoma. JAMA Oncology.
Stewart, A. F. (2005). Hypercalcemia associated with cancer. New England Journal of Medicine, 352(4), 373-379.
Marcocci, C., & Cetani, F. (2011). Primary hyperparathyroidism. New England Journal of Medicine, 365(25), 2389-2397.
No comments:
Post a Comment