Cachexia: cancer (cancer) and other types
Cachexia may be accompanied by many diseases of internal organs, and sometimes develops at the fault of the patient, seeking, at whatever cost, to get rid of excess, in his opinion, pounds.
The most common cause of cachexia become a severe disease of the Central nervous system, endocrine organs, and cancers, the idea of which most of us and is associated with sudden weight loss.
Not considered rare cases nutritional depletion associated with not enough incoming food, especially in countries with a low level of economic development, where the population can’t afford quality and sufficient food.
Without looking at the different causes of cachexia, manifestations of its rather stereotyped. As loss of body weight and consumption of fat reserves to provide the energy needs of the body, metabolic changes occur when the decomposition of substances begins to dominate over their synthesis, there is a deficiency of minerals and vitamins, needed for vital biochemical processes in cells, disturbed electrolyte composition of blood and, inevitably, suffering the function of internal organs.
On the course and outcome of this debilitating condition will affect the patient’s age, and its condition, and the root cause. It is clear that for cancer for cachexia will worsen the negative effect of the tumor, need aggressive treatment or surgery. The tumor itself in a short period of time can lead to exhaustion due to poisoning of the body products of their metabolism, metastatic lesions to internal organs, adverse effects on appetite or the possibility of natural meals. In cancer cachexia is considered one of the main symptoms of a progressing tumor, which requires skilled care and constitutes a threat to the life of the patient.
The causes of cachexia
The causes of cachexia are diverse:
- Nutritional factors – insufficient intake of nutrients from food due to a conscious rejection of its acceptance, lack of appetite, inadequacy of diet (veganism, unilateral unbalanced diets);
- Diseases of the gastrointestinal tract with malabsorption of nutrients (condition after resection of stomach, intestines, tumors, AC);
- Endocrine pathology (hypofunction of adrenal, thyroid, pituitary);
- Cancer (cancer cachexia);
- Mental illness in which the sufferer refuses to eat;
- Severe intoxication, infection, sepsis;
- Burn disease, severe injury;
- HIV infection in the terminal stage;
- Alcohol and drug addiction.
In accordance with a causal factor, it is customary to distinguish exogenous cachexia, when disrupted the flow of food from the outside, and endogenous, evolving because of the pathology of internal organs.
Cancer cachexia is usually accompanied by severe stages of the flow of a malignant tumor of the lung, digestive system, breast, brain. The development of malnutrition in cancer patients is due to the fact that the tumor absorbs a significant amount of nutrients into the bloodstream and emit toxic metabolic products toxic to the patient. The progression of the intoxication leads to a loss of appetite, up to complete refusal of food, nausea and vomiting.
Considerable importance is the aggressive treatment, when the background of chemo or radiation decay of the tumor tissue causes metabolic changes. A special group of patients are patients with cancer of the esophagus, oral cavity, stomach, intestine, when cachexia has a direct connection with the defeat of the digestive system, often making the act of eating impossible.
About alimentary cachexia say when the need for nutrients is not compensated for by food eaten. Causes can be diet, veganism, pathology of the digestive tract with malabsorption, tumors, in which decreased appetite, patients experience nausea and aversion to food or experience difficulties with its reception in lesions of the oral cavity, esophagus, larynx.
A special kind of alimentary cachexia is considered to be anorexia nervosa. More recently it has spread among the young girls and women, following the fashion for thinness, certainly to lose weight. Exhausting yourself diets, refusing a meal or replacing it with water, deliberately causing vomiting, such patients bring themselves to a state of extreme exhaustion, when the internal organs are violated to such an extent that health care becomes very difficult and ineffective, so the deaths from anorexia nervosa are periodically fixed.
As you lose weight, desire to lose weight joins psychogenic factor, and the patient ceases to adequately assess their condition, continuing the refusal to eat even when their way of life and self become more difficult. Anorexia nervosa patients need not only professional help from a nutritionist, endocrinologist, gastroenterologist, but also in psychotherapeutic treatment.
The so-called pituitary cachexia occurs with the pathology of the pituitary gland, when there is a death of cells due to thrombosis of feeding vessels, neuroinfections, tumors. A similar condition described as a syndrome Shihena, is found among women in the postpartum period, especially suffered DIC, severe blood loss, amniotic fluid embolism. Cell death of the anterior pituitary leads to decreased production of their hormones that regulate the activity of other peripheral glands, so the clinical picture will prevail reduction of body weight, neuro-vegetative disorders, hypotonia, psychiatric disorders, etc.
Cerebral cachexia means the defeat of the structures of the brain (traumatic brain injury, neuroinfections, tumors, coma), leading to exhaustion. Often this kind of cachexia develops in the pathology of the hypothalamus, which not only regulates the activity of the pituitary gland, but also serves as an important focal point for hunger and fullness. Severe vascular pathology of the brain and senile dementia can also lead to cachexia due to disorders of the brain, mental disorders, refusal of the patient from eating.
Depending on the magnitude of weight loss and the level of metabolic disorders there are three stages of cachexia:
In the last stage of cachexia, the patients completely refuse from food, possible impairment of consciousness, there is multiple organ failure, and life expectancy when diagnosed with terminal stage does not exceed three months.
Symptoms and diagnosis of cachexia
Symptoms of exhaustion in oncopathology usually indicate a severe stage of the tumor, but at the beginning of the cancer the patient may notice some weight loss.
As loss of body weight, which is considered as main symptom of increasing cachexia, patients develop:
- Weakness, fatigue, decreased performance;
- Skin dryness, peeling, trophic disorders, brittle nails, hair loss, wrinkled skin and a sharp paleness, yellowness;
- Mental disorders up to depression, tearfulness and emotional lability, drowsiness by day, insomnia at night;
- A tendency to low blood pressure and, as a consequence, fainting;
- Swelling («hungry» swelling as a result of violations of protein metabolism);
- Frequent recurrent infectious-inflammatory processes;
- Decreased libido, lack of menstrual periods in women.
As the main characteristic of exhaustion find weight loss due to subcutaneous fat and muscle tissue, the appearance of the patients is quite characteristic: wrinkled skin, virtually no fat, protruding bones, possible diffuse alopecia.
As a rule, the diagnosis of exhaustion, especially in the case of cancer pathology, is beyond doubt after a simple inspection and a conversation with the patient, however, further examination is necessary to assess the state of internal organs and the level of sharing in order to develop effective follow-up treatment.
Usually held in common and biochemical blood tests, General urine analysis, investigation of electrolyte composition of blood, ultrasound of internal organs, CT, MRI, if necessary, gastroscopy, etc. to help the oncologist can come other doctors – gastroenterologist, urologist, gynecologist, neurologist, psychotherapist and others.
Having established the existence of cancer cachexia and its degree, the doctors will begin to search for the most efficient schemes of dealing with this dangerous condition.
Treatment of cachexia
Treatment of cachexia may present a daunting task in patients oncological profile. It is connected not only with natural difficulties eating due to violation of appetite and changes in the gastrointestinal tract, but also with the peculiarities of the metabolism of cancer patients, the need for certain groups of nutrients. Patients undergoing surgical treatment of cancer, have experienced operational stress, further violating the metabolic processes in the body.
As practice shows, up to 20% of patients with exhaustion to have experienced malnutrition, half of them suffer from disorders of fat metabolism, and almost 90% have signs of vitamin deficiency. This is initially a severe violation of activity leads to significant difficulties in nutritional therapy and requires a skilled approach.
The choice of method to fill the lack of nutrients depends on the patient’s condition, degree of malnutrition, function of the digestive system and the ability to eat naturally. The so-called nutritional support is an essential component of the treatment undertaken in a hospital environment. Nutritional support involves the introduction of nutrient mixtures in different ways depending on the specific clinical situation.
The main event, designed to adjust the metabolic disorders, is considered a diet food, which needs to be developed for each patient dietitian. Be aware that a malignant tumor lead to a significant loss of energy and nutrients and increase the need for calories, so the food should be high calorie. Good nutrition is not only able to normalize the metabolism, but also enhance the body’s resistance to various infectious agents and adverse environmental factors.
Feeding patients with cancer cachexia has certain features that require the participation of a specialist. Independently, the patient with this severe complication can not cope.
Since the majority of patients with cancer suffer from lack of appetite and unwillingness to accept any food, it is often used:
- The bitterness, stimulating the appetite (wormwood tincture, for example) for 10-15 minutes before eating;
- Spices and condiments, non-irritating to the digestive tract (ginger, cinnamon, cumin, mint, pepper, mustard, etc.);
- Dairy products, acidic juices and fruits, pickled vegetables, and even wine or beer, of course, in moderation.
Food for cancer patients should be tasty and have an appetizing appearance. It is desirable to make it pleasant for the patient. The amount of portions should not be large, since in such cases not only will not be adequate digestion and absorption, but also the possible vomiting and, as a consequence, a full rejection of food.
In lesions of the oral cavity fungal process is assigned antifungals, rinsing with antiseptic solution, including plant origin (furatsilin, chamomile, sage).
Adequate nutritional support of the Oncology patient is designed to ensure increased energy consumption and normalize the function of the digestive system, body weight.
Nutritional support includes:
Depending on the method of filling the energy deficit nutritional support can be carried out in a natural way, when the patient himself is able to take proper food and nutrients, and artificially, with a full or partial introduction of formula through a tube.
Basic assistance is designed to compensate for the patient’s needs in basic nutrients through the ingestion of or by natural means or by introduction through a tube if you cannot supply that is often observed in patients with tumors of the esophagus, stomach, cancer of the oral cavity. To the effect of diet came faster, are assigned additional nutrient mixture rich in energy components.
Most patients have a deficiency of a trace mineral or vitamin, so extra nutritional support involves the introduction of them in the form of dietary supplements.
For each patient, the doctor expects not only its energy requirements in accordance with the level of exchange and the lack of a substance. Always take into account and stress associated with the presence of a tumor or the surgery, requiring additional consideration of energy consumption.
In the treatment of cachexia in cancer patient should be under the control of the laboratory parameters of blood and urine, which can not only evaluate the effectiveness of measures, and timely detect and resolve the possible complications of such therapy. Daily inspection, measurement of body temperature, pulse and blood pressure, daily urine is examined and blood tests are performed at least three times a week. Regular monitoring demand and biochemical indicators of blood serum, because most patients develop liver problems and kidney failure, and inadequate nutrition therapy can aggravate the phenomena of renal insufficiency or electrolyte disturbances.
If the patient can not eat, does not want to or diet is not enough to achieve a stable condition of the exchange, without additional measures are not necessary. Indications for such nutritional support may be:
- The inability of natural meals (operations on the esophagus, the stomach, inoperable tumors of the digestive system);
- Extreme exhaustion and weakness of the patient;
- The increased demand for nutrients on the background of oncopathology;
- Surgery, demanding the immediate restoration of the gastrointestinal tract.
Enteral nutrition can be carried out by the patient when eating by mouth, and perhaps the introduction of a probe through the gastric, intestinal fistula probe or of the stomach or intestines, derived during the operation on the anterior abdominal wall. The probe can be installed directly into the stomach, duodenum or the initial division of the jejunum. It is important as early as possible to ensure adequate supply of food in the digestive tract, as its absence leads to the atrophic changes of the mucosa, which will result in further difficulties in the transition to natural eating.
Modern nutritional formulas for enteral nutrition contain all the necessary components: proteins, fats, carbohydrates, minerals and vitamins. Their composition and quantity are calculated based on the daily needs of the patient, the function of the digestive and excretory systems. At risk of developing infectious complications against the background of the tumor, chemotherapy or radiation in the composition of the mixtures include immunomodulators.
If the patient has vomiting, diarrhea or food is not absorbed in the body itself, it shows the parenteral introduction, bypassing the gastrointestinal tract.
Parenterally administered different composition of the nutrient mixture, but because this way of compensating the energy needs is not physiological and can give complications, we resort to it only when there are serious indications.
In most cases, to achieve the best results in the shortest time spend a combination of different methods of administration of nutrients.
Mixtures for parenteral nutrition include:
Drug therapy of tumor cachexia include:
- The appointment of anabolic steroids, enhancing metabolic processes (retabolil, nerobolum et al, Megas), prednisolone and dexamethasone, which increases appetite;
- The use of enzymes to enhance the absorption of nutrients (Pancreatin holenzim), choleretic drugs;
- Correction of water-electrolyte disorders (fluid therapy, diuretics, calcetin, clodronate with hypercalcemia and calcium Supplement if hypocalcemia, a solution of sodium bicarbonate in hyperkalemia and acidosis, etc.);
- The introduction of antipsychotics and antidepressants in violation psycho-emotional sphere;
- Vitamins, especially ascorbic acid, b vitamins, and substances adaptogenic actions (a ginseng, eleuterokokk);
- When infectious-inflammatory complications of the mandatory antibiotic medication broad-spectrum, antiviral and antifungal agents;
- Adequate pain relief, especially incurable patients.
In the development of the scheme of nutritional support participate the dietician, surgeon, oncologist, transfusiologist and clinical pharmacologist with knowledge about nutritional compounds and methods for their use. At all stages of treatment of cachexia in cancer, a thorough clinical and laboratory monitoring of patient’s status, blood and urine, the level of metabolic processes and dynamic analysis of the effectiveness of treatment.
In addition to medical interventions aimed at restoring the metabolism and elimination of cachexia, it is important and a way of life: fresh air, a feasible physical activity, communication with relatives, entertainment, Hobbies.