Hypercalcemia of Malignancy: Diagnostic and Therapeutic Challenges

Background. Malignancy-associated hypercalcemia (HHM) is a frequent metabolic complication in advanced cancer, often leading to neurological deterioration, cardiovascular disturbances, reduced functional status, and shorter survival. In palliative care, timely diagnosis and management of HHM are essential to improve symptom control and patient comfort. Aim. To present a comprehensive, evidence-based review of current diagnostic and therapeutic approaches to hypercalcemia of malignancy, with a focus on palliative care settings. Material and methods. A narrative review was conducted using databases such as PubMed, MEDLINE, Google Scholar, and Europe PMC. Fifty-six articles published between 1994 and 2024 were selected based on clinical relevance and scientific quality. Results. Hypercalcemia in malignancy arises predominantly from PTHrP secretion, calcitriol overproduction, or local osteolysis. Diagnostic workup includes calcium profile, PTH/PTHrP levels, and imaging. Management involves intravenous hydration, bisphosphonates, denosumab, glucocorticosteroids, and—occasionally—calcitonin or hemodialysis. Timely treatment improves symptoms and may enable continuation of oncologic therapies. In palliative patients, hypercalcemia often necessitates a shift toward comfort-focused care and underscores the importance of interdisciplinary management. Conclusions. Malignancy-associated hypercalcemia significantly worsens prognosis and quality of life in advanced cancer. Individualized treatment—including rehydration, anti-resorptive agents, and symptom control—is essential. Effective calcium regulation alleviates suffering, facilitates supportive care, and should be integrated into comprehensive palliative strategies.