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Metabolic Disturbance in Cancer Patients

  • Chapter
International Manual of Oncology Practice

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Abstract

Patients with cancer are at risk for metabolic disorders. The pathophysiologies include organic dysfunction due to systemic dissemination, dysfunction due to anticancer treatment, paraneoplastic metabolic changes due to tumor proliferation mechanisms, and metabolites production. The main metabolic emergencies in cancer patients are the tumor lysis syndrome, hypercalcemia, hyponatremia, and adrenal insufficiency.

Tumor lysis syndrome is characterized by various electrolyte abnormalities, including hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and metabolic acidosis. Trigger factors are an increased lactic dehydrogenase, solid tumors with a large volume disease, rapid tumor growth, or a high sensitivity to chemotherapy. Treatment is based on maintaining urinary output, stimulating potassium and phosphorus excretion, and avoiding the precipitation of calcium and uric acid in the renal tubules. It is necessary to consider early hemodialysis in those with renal insufficiency.

Hypercalcemia is the main electrolyte disturbance in cancer patients. The main differential diagnosis is primary hyperparathyroidism; however, in cancer, the parathyroid hormone values are low or normal. Venous hydration and bisphosphonates have a great impact on malignant hypercalcemia. When the blood volume is restored, it is important to consider the use of diuretics. Hyponatremia occurs generally because of the ectopic production of the antidiuretic hormone-like effect in cancer patients, which causing inappropriate antidiuretic hormone action. The treatment aims to increase the serum sodium with parenteral solutions.

Adrenal insufficiency is caused by the metastatic spread to the adrenal glands or by the chronic use of corticosteroids. In cases of hemodynamic instability, corticosteroid replacement must be administered intravenously and immediately.

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Authors and Affiliations

  1. Department of Medical Oncology, Federal University of São Paulo, UNIFESP, Rua Pedro de Toledo, 377, CEP 04039-031, São Paulo, SP, Brazil

    Carmelia Maria Noia Barreto M.D., Maria Cecilia Monteiro Della Vega M.D., Michelle Samora de Almeida M.D. & Hakaru Tadokoro M.D., Ph.D.

  2. Department Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal

    Ramon Andrade de Mello M.D., Ph.D.

  3. Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal

    Ramon Andrade de Mello M.D., Ph.D.

Authors
  1. Carmelia Maria Noia Barreto M.D.
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  2. Maria Cecilia Monteiro Della Vega M.D.
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  3. Michelle Samora de Almeida M.D.
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  4. Hakaru Tadokoro M.D., Ph.D.
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  5. Ramon Andrade de Mello M.D., Ph.D.
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Correspondence to Ramon Andrade de Mello M.D., Ph.D. .

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Editors and Affiliations

  1. Medical Oncology, University of Algarve, Faro, Portugal

    Ramon Andrade de Mello

  2. edificio 7, ala nascente, 3º andar, University of Algarve, Dept Cie Biomed edificio 7, ala nascente, 3º andar, Faro, Portugal

    Álvaro Tavares

  3. Medical Oncology, University of Athens, Athens, Greece

    Giannis Mountzios

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Barreto, C.M.N., Della Vega, M.C.M., de Almeida, M.S., Tadokoro, H., de Mello, R.A. (2015). Metabolic Disturbance in Cancer Patients. In: de Mello, R., Tavares, Á., Mountzios, G. (eds) International Manual of Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-21683-6_33

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