Answer and Discussion of Quiz Set: W-003

2.    Metastatic carcinoma does not always need extensive bone destruction to cause hypercalcemia?

A.  True.

B.  False.

Answer and Discussion: The answer is (A). While metastatic cancer with widespreade bone destruction, examples are renal cell carcinoma and myeloma, can cause hypercalcemia. Multiple myeloma is a good example. Tumor cells and inflammatory cells produce osteoclast-activating factors including cytokines such as interleukin-1, tumor necrosis factor, transforming growth factor, and prostaglandin that leads to local osteolytic changes that contribute to hypercalcemia. Circulating hypercalcemic factors can cause hypercalcemia through a systemic fashion. The clinical syndrome is a result of the production of parathyroid hormone-related protein (PTHrP) which causes hypercalcemia. Squamous cell carcinoma, and carcinoma from the kidney, urinary bladder and ovary can cause hypercalcemia in this fashion.