A 72-Year-Old Woman With Back Pain and Hypercalcemia

Tarah Ballinger, MD; Kathy D. Miller, MD


July 27, 2016

Patients with breast cancer may also be at increased risk for other solid-tumor malignancies owing to an underlying germline mutation, independent of what cancer treatments they have received. For example, patients with a BRCA1 or BRCA2 mutation are also at increased risk for ovarian, colon, pancreatic, and prostate cancers (the latter two are more commonly associated with BRCA2). Patients with breast cancer who are receiving a selective estrogen receptor modulator, such as tamoxifen, are at increased risk for endometrial cancers, with a lifetime risk of 1%-2%.[16]

DLBCL is a rarer secondary cancer. Whether this patient's prior therapy for breast cancer contributed to the development of her lymphoma is unclear. DLBCL is the most common type of lymphoma and accounts for approximately 25% of all non-Hodgkin lymphomas.[17] This patient's presentation is atypical, and patients usually present with a rapidly enlarging nodal mass or "B" symptoms, including fevers, drenching night sweats, and weight loss. Like this patient, approximately 40% of patients have involvement outside of the lymph nodes.

The patient's lymphoma was considered advanced stage, or stage IV by the Lugano staging system, owing to diffuse involvement of organs outside the lymphatic system and the fact that the disease could not be contained in a single field for radiation therapy.[11] She was therefore treated with six cycles of cyclophosphamide, vincristine, doxorubicin, and prednisone, along with the anti-CD20 antibody rituximab (R-CHOP). In addition, her hypercalcemia was treated with the bisphosphonate zoledronic acid. She tolerated her therapy well and achieved complete remission.


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