Cancer patient malnutrition

Weight loss is a hallmark sign of malnutrition in the cancer patient and correlates with decreased survival for some cancer types. 

Improved nutrition stains enhances snrvival and improves treatment tolerance in many but not all children. Mahmtrition in cancer patients due to simple starvation, characterized by normal metabolism but inadequate nutrient intake or malabsorption, appears to be responsive to nutrition intervention. However, malnutrition due to cancer cachexia, characterized by altered nutrient use despite adequate supply, does not. " ... 

TABLE 136—4. Risk Factors for Malnutrition in Cancer Patients... 

For the above retisons, and probably others yet unknown, cancer patients often exhibit cachexia—a general lack of nutrition. Hence, steps should be taken to correct the malnutrition and fluid and electrolyte imbalances in order for other therapeutic measures to proceed—and succeed. 

Supportive—Cancer victims who, Isecause of malnutrition caused by cancer, are a poor risk for other forms of therapy for example, suigery. The risk of this type of cancer patient can h)e clinically lowered by nutritional means before undertaking other forms of therapy. 

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite. It is seen in patients with cancer, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease and congestive heart failure. Underlying causes are poorly understood, but there is an involvement of inflammatory cytokines, such as TNF-a, IFN-y, IL-6 and tumour-secreted proteolysis-inducing factor. Related syndromes are kwashiorkor and marasmus, although these are most often symptomatic of severe malnutrition. 

There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. Patients with chronic diseases like cancer, AIDS, and intestinal disorders may lose weight rapidly and become susceptible to undernourishment because they cannot absorb valuable vitamins, calories, and iron. 

Recurrence or metastatic spread of the breast cancer would need to be excluded in this woman by imaging her liver and skeleton. Alkaline phosphatase isoenzyme studies should be performed. However, if the increase is due to an increased bone activity, this does not necessarily represent metastatic spread of the tumour. In view of the history and symptoms, osteomalacia due to malnutrition or malabsorption may be the reason. If the patient has malabsorption or malnutrition she may have a macrocytic anaemia due to folate or deficiency and may be deficient in other micronutrients such as zinc and other vitamins. Malabsorption is often difficult to detect clinically and she should undergo tests of malabsorption such as faecal fat measurement. 

Malignant fistulas between the esophagus and the respiratory system are a serious complication of esophageal cancer and occur in 5%-15% of patients (Martini et al. 1970 Little et al. 1984 Duranceau and Jamieson 1984). They may arise spontaneously as a result of tumor invasion or they may be caused by radiation therapy, surgery, pressure necrosis caused by a previously placed plastic or metallic stent, or laser therapy (Burt et al. 1991 Duranceau and Jamieson 1984 Saxon et al. 1994 Cwikiel et al. 1998). The onset of symptoms of aspiration is a devastating development for patients aheady debilitated by malnutrition caused by the dysphagia. Patients are often unable to swallow their own saliva without aspirating. 

Oral mucositis is a consequence of the toxic effects of chemotherapeutic agents and irradiation on oral mucosa cells. It is estimated that oral mucositis is a complication in 40% of patients receiving chemotherapy, more than 90% of those irradiated for head and neck cancer. This condition is frequently associated with severe pain and inflammation and can cause malnutrition, systemic infections, and low quality of life, as well as limiting efficiency of the chemotherapy [39]. 

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