CALCIUM STATUS IN SUDANESE CANCER PATIENTS ATTENDING THE INSTITUTE OF NUCLEAR MEDICINE, MOLECULAR BIOLOGY AND ONCOLOGY
Objective: The aim of this study was to study the incidence of hypercalcaemia together with the related biochemical parameters and anthropometric measurements in Sudanese cancer patients attending the Institute of Nuclear Medicine, Molecular Biology and Oncology (INMO), Gezira State, Sudan.
Methods, materials and study subjects: The study was a prospective study performed on 100 cancer patients (age ranging between 4- 70 years). The study period was from 15/4/2003 to1/9/2003. Another 100 persons (age and sex matched) were used as control group. The biochemical parameters measured in this study were serum calcium, serum inorganic phosphorus and serum albumin. Calcium, inorganic phosphorus and albumin were measured by Spectrophotometery. Anthropometrics measurements determined were weight and height. A questionnaire was filled in order to obtain information regarding: age, sex, residence, tribe and information about education, occupation, marital status and past medical history. Type of cancer, date of diagnosis, stage of cancer, treatment, and present complaints were recorded.
Results: Hypercalcaemia was detected in ten of the patients (10%). This is similar to the internationally published rates. The types of cancers associated with hypercalcaemia were cancer of the breast (20%), skin (20%), prostate (10%), bladder (10%), rectum (10%), unknown primary (10%) and hematological malignancies (20%).Mean serum calcium (9.48 ± 1.07 mg/dL) and inorganic phosphorus (4.45 ± 1.01 mg/dL) were higher in the cancer patients than the control group (9.03 ± 0.56, 4.13 ± 0.72 mg/dL respectively). However, the difference is statistically not significant. Serum albumin concentration was similar in the patients and control groups (4.97±0.63 and 4.93±0.41 g/dL respectively). The differences of weight and height were not significantly different in the two groups.
Conclusion: It is concluded that the calcium, phosphorus and albumin levels among Sudanese individuals were similar to the internationally published levels. Hypercalcaemia is not a rare condition among cancer patients and should be checked whenever there is a symptom because it can lead to many serious complications.
2- Sukkar M.Y. Human Nutrition, for medical studies and allied health sciences.First edition, 1982, page 28-29.
3- Williams S R, 2001. Basic Nutrition and Diet Therapy. 11th edition. Mosby, Page 114-117.
4- Cantaraw A and Trumper M, 1962. Clinical Biochemistry.6th edition, Saunders Company, Philadelphia, pages 216-246.
5- Holland JF.1993. Cancer medicine. Third edition by Lea and Febiger, USA, pages 2291-2292.
6- Warrell RP, 1992. Etiology and current management of cancer-related hypercalcaemia. Oncology 6 (10): 37-43; pages 47-50.
7- Djulbegovi’c B and Sullivan DM, 1997. Decision making in oncology, evidence-based management. First edition, Churchill Livingstone, USA, page 437-445
8- Vassilopoulou R et al.1993. Incidence of Hypercalcemia in Patients with Malignancy referred to a Comprehensive Cancer Center. International Journal of the American Cancer Society, No.4, Volume11, P 1309-1312.
9- Gezira Radiotherapy Hospital. Institute of Nuclear Medicine, Molecular biology and Oncology. Annual Report 2001.
10- Bajorunas DR, 1990. Clinical manifestation of cancer-related Hypercalcaemia. Semin Oncol. 17(2 Suppl 5): 16-25.
11- Mahon SM, 1989. Signs and symptoms associated with malignancy-induced hypercalcaemia. Cancer Nurs 12(3): 153-60.
12- Binns A and Gurney, 1998. Update on hypercalcaemia in malignancy. Palliative care. www.medicine.net.au.
13- Hemphill RR and Gossman W. Hypercalcaemia. Medicine Jorurnal, January 2002, Volume3, Number1.
14- Suki WN et al, 1970: Acute treatment of hypercalcaemia with furosemide. N Engl J Med 283(16): 836-40.
15- Siuddiqui I et al, 2002. Tumor-induced hypercalcaemia: predictor of early mortality. J. Pak. Med. Assoc. Aug; 52(8): 361-4.
16- Toma S N et al. 1998. Tumor induced hypercalcaemia in metastatic breast cancer: treatment and predictive factors. European society for medical Oncology, Archived Abstracts. No: 139, pages 1-2.
17- Horiuchi N et al. 1987. Similarity of synthetic peptide from human tumor to parathyroid hormone in vivo and in vitro. Science 1987, 238 (4833): 1566-8.
18- Sura LJ et al, 1987. Aparathyroid hormone-related protein implicated in malignant hypercalcaemia: cloning and expression. Science 1987, 237(4817): 893-6.
19- Ganong WF, 1999. Review of medical physiology. 19th edition. Appleton and Lange, Stamford, P365-377.
20- Ritch SH, 1990. Treatment of cancer-related hypercalcaemia. Semin Oncol 17(2Suppl5): 26-33.
21- Beers MH and Berkow R, 1999. The Merck manual of diagnosis and therapy.17th edition, Whitehouse Station, NJ: Merck Research Laboratories.
22- Diamond TH et al, 1987. Hypercalcaemia in the Johannesburg Hospital. Differential diagnosis and physician awareness of primary hyperparathyroidism. S Afr Med J. 1987 Jul 18; 72(2):113-5.