Hematology and Oncology Book

Cancer

  • Cachexia in Cancer

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Cachexia in Cancer

Aka: Cachexia in Cancer, Anorexia in Cancer, Wasting Syndrome in Cancer, Anorexia-Cachexia Syndrome, Cachexia in Terminally Ill Patients, Cancer Related Cachexia, Cancer Cachexia
  1. See Also
    1. Unintentional Weight Loss
  2. Pathophysiology
    1. Results in wasting of body fat and Muscle
    2. Cytokine elevations related to Wasting Syndromes
      1. Interferon
      2. Tumor Necrosis Factors
  3. Symptoms
    1. No appetite (Anorexia)
    2. Unintentional Weight Loss (Cachexia)
    3. Fatigue (see Fatigue in Cancer)
  4. Differential Diagnosis
    1. See Unintentional Weight Loss
    2. Chronic organ failure
    3. Serious chronic infection
    4. AIDS
  5. Evaluation: Identify and treat reversible causes
    1. Chronic Pain
    2. Pancreatic exocrine enzyme insufficiency
    3. Diminished gastrointestinal motility
      1. Constipation
      2. Reflux Esophagitis
      3. Gastroparesis
    4. Mouth condition
      1. Dry Mouth (Xerostomia)
      2. Dental or jaw related issues
      3. Chemotherapy related Oral Mucositis
      4. Infection
        1. Oral Candidiasis
        2. Oral Herpes Simplex infection
  6. Management: Nutrition
    1. Background
      1. Wasting is not reversed by improved nutrition
      2. Aggressive alimentation may increase discomfort
    2. Management
      1. Small Frequent Meals
      2. Avoid blended, pulverized foods
      3. Avoid parenteral nutrition
      4. Patient eats what they want
        1. Avoid dietary restriction (diabetics eat ice cream)
        2. Avoid foods with unpleasant odor
      5. Educate families that wasting is not inadequate care
      6. Families can offer care in alternative ways
        1. Moisten patient's lips or mouth with sponge
        2. Offer massage
        3. Read or play soft music for patient
  7. Management: Medications
    1. General
      1. Discontinue medication if no benefit in 2-6 weeks
    2. Main options
      1. Megestrol acetate (Megace) 200 mg PO q6-8 hours
      2. Dexamethasone (Decadron) 2 to 20 mg PO qAM
      3. Dronabinol (Marinol) 2.5 mg PO bid to tid
      4. Medroxyprogesterone acetate
    3. Experimental: Androgens
      1. Oxandrolone (Oxandrin)
      2. Nandrolone (Durabolin)
    4. Other options
      1. Macrolide antibiotics
      2. Cyproheptadine
      3. Hydrazine sulfate
      4. Cannabinoids
  8. References
    1. MacDonald (2003) J Am Coll Surg 197:143-57 [PubMed]
    2. McCann (1994) JAMA 272:1263-6 [PubMed]
    3. Nelson (2000) Semin Oncol 27:64-8 [PubMed]
    4. Ross (2001) Am Fam Physician 64(5):807-14 [PubMed]

Wasting Syndrome (C0043046)

Definition (MSH) A condition of involuntary weight loss of greater then 10% of baseline body weight. It is characterized by atrophy of muscles and depletion of lean body mass. Wasting is a sign of MALNUTRITION as a result of inadequate dietary intake, malabsorption, or hypermetabolism.
Concepts Disease or Syndrome (T047)
MSH D019282
ICD10 R64
SnomedCT 207559001, 271878009, 288517002, 28928000
English Wasting Disease, Wasting Diseases, Wasting Syndrome, Wasting Syndromes, [D]Wasting disease, [D]Wasting disease (context-dependent category), WASTING DIS, Wasting generalized, Wasting Syndrome [Disease/Finding], wasting diseases, wasting disease, wasting syndrome, Wasting syndrome, Wasting disease (finding), [D]Wasting disease (situation), Wasting generalised, Malnutrition/starvation/cachexia, Wasting disease, Wasting disease (disorder), disease (or disorder); wasting, disease; wasting, syndrome; wasting, wasting; disease, wasting; syndrome, Wasting disease, NOS
Dutch algehele vermagering, aandoening; slopend, slopend; aandoening, syndroom; uittering, uittering; syndroom, ziekte; uittering, Syndroom, Wasting-, Wasting-syndroom
German Verfall generalisiert, Auszehrungssyndrom, Wasting-Syndrom, Auszehrungskrankheit
Italian Deperimento generalizzato, Wasting sindrome
Spanish Consunción generalizada, [D]enfermedad emaciante (categoría dependiente del contexto), [D]enfermedad emaciante, [D]enfermedad emaciante (situación), Síndrome de Consunción, enfermedad consuntiva (trastorno), enfermedad consuntiva, enfermedad emaciante, Enfermedad Debilitante, Síndrome Debilitante
Swedish Tärande syndrom
Czech syndrom chřadnutí, Generalizované chřadnutí
Finnish Näivetysoireyhtymä
French Syndrome de dépérissement, Cachexie généralisée, Syndrome cachectique, Syndrome de cachexie progressive, Syndrome de cachexie
Russian ISTOSHCHENIIA SINDROM, ИСТОЩЕНИЯ СИНДРОМ
Polish Choroba wyniszczająca, Zespół wyniszczenia
Japanese 消耗疾患, 消耗性症候群, ｾﾞﾝｼﾝｾｲｼｮｳﾓｳ, 全身性消耗, 消耗症候群, 消耗性疾患, 消耗病
Norwegian Tærende syndrom, Tæring sykdom, Tærende sykdom
Hungarian Generalizált sorvadás
Portuguese Consumpção generalizada, Síndrome do Definhamento, Doença do Definhamento, Doença do Emagrecimento, Doença Consumptiva, Doença de Emaciação, Síndrome de Emaciação
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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