Cancer Genes, Cachexia and Death

25 years ago, then President Nixon declared War on Cancer. In this personal commentary, the war is reviewed. There have been obvious triumphs, for instance in cure of acute lymphocytic leukaemia and other childhood cancers, Hodgkin s disease, and testicular cancer. However, substantial advances in molecular oncology have yet to impinge on mortality statistics. Too many adults still die from common epithelial cancers. Failure to appreciate that local invasion and distant metastasis rather than cell proliferation itself are lethal, obsession with cure of advanced disease rather than prevention of early disease, and neglect of the need to arrest preneoplastic lesions may all have served to make victory elusive. 

In 1848, Rupert Willis, a British pathologist, defined a tnmour as a mass of tissue the growth of which exceeds and is uncoordinated with that of normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change . 

Malnutrition, and its ultimate form cachexia, are encountered every day in cancer and haematology wards. Malnutrition results from the parasitic metabolism of the tumour at the expense of the host, from the impact of the tumour on the metabolism of the host... The major consequence is an increased risk of complications and death during the course of chemotherapy, radiation therapy and major surgery. It is thus important to offer nutritional support, in order to stop or reverse the process of malnutrition. Nutritional intervention should be founded on the abundant literature devoted to cancer cachexia, including the pathophysiology of the disease. .. 

Along with coronary heart disease, cancer is one of the major causes of death in developed countries and increasingly so in developing countries. At least one person in three in developed countries will develop cancer and one in four men and one in five women will die from it. The incidence of cancer increases with age, particularly above 45 years. Although the number of cases of cancer is expected to be more than 14 million worldwide by 2020, it is claimed that most cancers are avoidable because they are caused by unhealthy food, an unhealthy lifestyle and/or 

Most cancers in humans can be divided into three groups according to age (i) embryonic tumours (neuroblastoma, Wilms tumour) (ii) tumours found mainly in the young (leukaemias, bone, testis) and (iii) tumours that appear frequently in middle and old age (prostate, colon, skin, bladder and breast). 

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