Cachexia
Cachexia, often referred to as wasting syndrome or anorexia-cachexia syndrome, is a complex condition characterized by significant loss of muscle and fat due to alterations in the body's metabolism, particularly concerning fats and carbohydrates. It is commonly associated with advanced cancers, especially those affecting the upper gastrointestinal tract and lungs, but can also occur in diseases like AIDS. Individuals with cachexia often experience severe fatigue, reduced appetite, and substantial weight loss of 10% or more of their body weight. Despite nutritional interventions, the condition is typically irreversible while the underlying disease persists.
Diagnosis usually involves clinical assessment, including monitoring unexplained weight loss and fatigue, and may include blood tests and imaging studies to identify the cause. Current treatment strategies focus on managing the underlying illness, with promising research ongoing into various medications aimed at treating cachexia directly. The prognosis for those with cachexia in advanced stages of illness is generally poor, and it is a significant factor in cancer-related mortality. Research has also explored the involvement of cytokines in cachexia, revealing their role in increasing metabolism and affecting muscle mass.
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Subject Terms
Cachexia
ALSO KNOWN AS: Wasting syndrome, anorexia-cachexia syndrome
RELATED CONDITIONS: Anorexia
DEFINITION: Cachexia is a complex syndrome in which changes in the way the body uses food, particularly fat and carbohydrates, lead to loss of muscle and fat. Anorexia (loss of appetite) is sometimes, but not always, associated with cachexia.
Risk factors: Certain cancers, such as lung cancer or any cancer of the digestive tract, particularly of the esophagus, stomach, and pancreas, are more likely to be accompanied by cachexia. It is also common in advanced cancer, although infrequently, it occurs in early cancers, sometimes even before diagnosis. Cachexia can also occur with acquired immunodeficiency syndrome (AIDS).
Etiology and the disease process: In cancer-related cachexia, it is thought that the tumor releases chemicals that change food metabolism. Patients with cachexia tend to have poor appetites. Even with nutritional supplementation, the wasting cannot be reversed while the cancer remains.
Incidence: According to Cancer Research UK, about 80 percent of patients with cancers in the upper gastrointestinal tract and 60 percent of patients with cancers of the lung have already lost considerable weight. The National Cancer Institute reported cachexia is the immediate cause of death in 20 to 40 percent of cancer patients. Patients with any except breast cancer are generally more prone to cachexia, and it is also more common and more pronounced as the disease progresses in children and older persons.
Symptoms: Cachexia is one of the most overwhelming symptoms of cancer, demolishing with numbing fatigue, loss of appetite or changes to taste, and severe weight loss of 10 percent or more of body weight.
Screening and diagnosis: When a person experiences unexplained weight or appetite loss or fatigue, medical practitioners without more specific clues might perform such general screens as a complete blood count and a chest X-ray. When the source of the problem is suspected, tests are more specific.
With a known cancer, cachexia diagnosis is based on clinical history, substantial weight loss, and physical examination. The concentration of plasma albumin in blood will usually be low. Extensive diagnostics are not normally required.
Treatment and therapy: The best course of action for cachexia is treatment of the underlying disease. After successful treatment, patients regain lost muscle and fat mass. In the mid-2020s, several medications were being studied for the possible treatment of cachexia. Possible treatments under investigation include: Anamorelin hydrochloride, which is a ghrelin receptor agonist; ruxolitinib, which is a JAK inhibitor; and IL-15 and growth differentiation factor-15, which are both cytokines.
Prognosis, prevention, and outcomes: Prognosis is very poor with cachexia in advanced disease. When cachexia occurs in the early stages of cancer, the cancer that causes it is often responsive to treatment, and successful treatment removes the source of changes to metabolism. The NCI reports that cachexia can be attributed to nearly one-third of cancer deaths. In 2017, preliminary drug trials on canine patients were underway to study the cytokines implicated in the disease. Initial results were promising, with a percent of the subjects gaining back an average of 7.5 percent of their body weight. The hope is this research will lead to additional studies and the development of drug treatments for humans. As research continued into the 2020s, studies found a clear link between cytokines and cachexia. This research confirmed cytokines increased metabolism. Additionally, cytokines led to an incease in cortisol and a decrease in muscle mass.
Bibliography
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