Evaluation of prognostic factors and the role of chemotherapy in unfavorable carcinoma of unknown primary site: a 10-year cohort study
A retrospective review of all head and neck cancers seen between January 1, 1975, and September 1, 1981, at Harper-Grace Hospitals, Detroit, Michigan, was performed. Of 1438 patients with head and neck cancers, 41 (2.9%) had hypercalcemia (calcium greater than 11.0 mg%) during the course of their disease. The incidence of hypercalcemia by site was 13 of 351 (3.7%) larynx, 7/280 (2.5%) pharynx, 19/733 (2.6%) oral cavity (floor of mouth 4/171, tongue 9/209, tonsil 5/176, palate 1/95, other 0/82, 2/26 (7.7%) nasal cavity, and 0/48 salivary gland carcinomas. Chest radiograph results were positive for mass lesions in 17/35 (49%). Bone scans and/or x-ray results were positive in 15/31 (48%), negative in 16/31 (52%), and were not evaluated in 10 patients. Of five patients tested, all had inappropriately elevated serum parathyroid hormone (PTH) for their serum calcium level. The hypercalcemia was medically treated in 29/41 (70%), with return-to-normal calcium levels in 17/29 (59%). Twelve patients (30%) received only terminal care. Survival from the diagnosis of hypercalcemia ranged from 1 to 514+ days (mean, 80+ days; median 33 days). It is concluded that hypercalcemia is unusual in head and neck carcinoma. Furthermore, hypercalcemia frequently is a late manifestation and terminal event. Finally, hypercalcemia in some patients may be mediated by PTH production.