Tumors Causing Hypercalcemia

Table 61-1 shows the frequency of individual tumors in collected series of patients with hypercalcemia. The most common single cause of hypercalcemia is lung carcinoma. Lung carcinomas with squamous or large-cell histology produce hypercalcemia frequently, but small-cell carcinoma almost never does.8 About two thirds of lung cancer patients have bone metastasis when hypercalcemia develops. In the remainder, hypercalcemia clearly has a humoral basis, usually humoral secretion of the parathyroid hormone-related protein (PTHrP), as discussed later. Together, lung carcinoma, breast carcinoma, and multiple myeloma account for more than 50% of all cases of malignancy-associated hypercalcemia. Among other solid tumors, the most common are squamous carcinomas of the esophagus and female reproductive tract and renal carcinoma. Gastrointestinal tumors and prostate carcinoma are less common causes of hypercalcemia. Among hematologic malignancies, hypercalcemia is common in multiple myeloma but distinctly uncommon in lymphomas and leukemia.

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