Page 14 - Diagnosis and clinical consequences of cachexia in patients with advanced cancer Susanne Blauwhoff-Buskermolen

Chapter 1
Cancer
Tumor products
(PIF, Activin A, ZAG, PTHrP)
Figure 1. Metabolic alterations in cancer leading to muscle and fat wasting and anorexia (‘cancer cachexia’)
Cancer cachexia
Cachexia was already recognized by Hippocrates (460-370 B.C.); the word ‘cachexia’ is derived from the Greek words ‘Kakos’ and ‘Hexis’, which means bad condition (30). Cachexia has frequently been described as a “...multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.The pathophysiology is characterized by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism” (2).
The prevalence of cancer cachexia depends on tumor type and method used to de ne cachexia but is estimated to be 50-80 percent in advanced cancer (31). The prevalence of severe weight loss does not seem to have changed the past 30 years but because prevalence of overweight and obesity increased, the diagnosis of cachexia may nowadays be more dif cult as it is less visible (32). Despite the fact that cancer cachexia has been recognized as an adverse effect of cancer for a long time, active assessment or management has not become standard of care due to lack of diagnostic criteria (2). In the past years, efforts have been made to create a diagnostic framework to increase detection of cancer cachexia. In 2008, Evans and colleagues presented a general framework to diagnose cachexia within all chronic diseases with a key component of at least 5% loss of body weight during the previous twelve months or less. Other diagnostic criteria for cachexia included
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Systemic inflammatory response (TNF-α, IL-1, IL-6)
Anorexia
Muscle and fat wasting