Nutritional manifestation of cancer ♋

• Each diseases type has its own unique characteristics there for specific sign and symptom will correlate with the specific diagnosis.

• Yet there are common signs and symptom that an individual may experience.

• This signs and symptoms such, as pain, infection, anaemia, fatigue, and malnutrition may result from the fact of the tumor on nearby body systems.

   Cachexia;

• Cachexia is characterized by involuntary weight-loss, tissues wasting ( partially) lean body mass and adipose tissues) in ability to perform daily activities and metabolic alternation.

• It is one of the most common causes of death among patients with cancer and is present in 80% at death.

• Metabolic alteration in glucose, amino acid/ protein and lipid metabolism can have an impact on the patients nutritional and medical status with the subsequence impact on quality of life, morbidity and mortality.

   Pathophysiology of cachexia;

 Pathophysiology of Cancer cachexia is not completely understood, it seems to be a attribute, at     least in part.

• This alteration thought to be personally attributable to increased levels of circulating;

• C reactive protein
• Fibrinogen
• White blood cells
• Pro-inflammatory cytokines (e.g.1l, 1l-6  TNF-a)

   Specificity of cachexia;

• ''Cachecti factors'' are presumably tumor-specific.

• For example, lungs and gastrointestinal tumor including pancreatic cancer are well known for causing cachexia with much higher incidence then breast and hematopoietic tumors.

• Changes in taste and smell perception physiological factors, and uncontrolled pain and therapy induced side effect also play an important role in the severity of cachexia but vary form one patients to another.

   Phases of cancer cachexia;

Cancer cachexia has been described an involving three phases;

• Pricachexia
• Moderate cachexia
• Advance cachexia

• Upon clinical examination of the patients, cachexia may be further classified into symptomatic and asymptomatic cachexia.

• Standard method of nutritional therapy including enteral and parenteral nutrition support, may not be effective in improving the outcomes of Cancer patients due to alteration in metabolism.

   Diagnosis;

• There are no standard criteria with which to diagnosis cachexia.
• Diagnosis usually stem from the presenting sign and symptoms.
• These include weight loss,, muscle wasting, fatigue and early satiety.

Abnormalities in carbohydrate protein and lipid metabolism;

• The normal physiologic conversation mechanism seen during periods of simple starvation do not occur in the presence of cancer.

• During periods of simple starvation, free fatty acid from  adipose tissues supply to the liver and muscle.

• The free fatty acid are converted to ketone bodies that can then be utilized by most tissues in the body as a source of energy.

• Ketone bodies inhibit glucose utilization and protein degradation from lean body mass.

• Therefore, protein is not used as a primary energy source.

• Serum insulin levels decline with increasing ketone body formation.

   CHO metabolism;

• The most important carbohydrates abnormalities are insulin resistance, increased glucose synthesis gluconeogenesis and decrease glucose tolerance and turnover.

• Changes in carbohydrate metabolism in Cancer patients probably arise as a consequence of meeting the metabolic demands of the tumor and may contribute to the development of the cachectic state.

   Protein metabolism;

• In cancel cachexia, amino acid not spread as they are during simple starvation and depletion of lean body mass occurs.

• Muscle wasting may be due to increased protein catabolism hyper catabolism for decrease protein synthesis, the simultaneous presence of both results in the most intense muscular atrophy.

• Simple anorexia alone cannot fully explain wasting of lean body mass and increase protein breakdown in Cancer cachexia.

   Lipid metabolism;

• Alteration in lipid metabolism also occur in the presence of malignancy.

• Fat the the body's primary fuel source.

• Abnormalities that occur in the presence of Cancer include.

• Increase lipid metabolism,

• Decrease lipogenesis

• Decreased  activity of lipoprotein lipase (LPL), the enzyme responsible for triglyceride clearance from the plasma.

• Mobilization of fatty acids from adipose tissues may occur before weight loss' suggesting  the presence of a lipid- mobilizing factor (LMF) produce either by the tumor or host tissues.

     What are clinical manifestation and nutritional problem associated with cancer?

     What is cachexia syndrome that occur in cancer patient?

   Cancer nutrition intervention

   Cancer definition

 

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