Cachexia is an extreme degree of depletion of the body, which is characterized by a sharp depletion of the body, weakness, reduced activity of physiological processes, and mental disorders are observed.

Causes of cachexia

There are many reasons for the appearance of cachexia, among them there are:

• starvation,
• malnutrition for a long time
• damage to the esophagus, which prevents the flow of food into the stomach,
• diseases of the digestive system with indigestion,
• food absorption,
• anorexia,
• prolonged intoxication,
• purulent processes,
• amyloidosis,
• connective tissue diseases,
• heart failure,
• endocrine diseases,
• accompanied by a violation of energy metabolism.

Symptoms of cachexia

• Marked weakness
• Decreased performance
• Sudden weight loss
• Dehydration
• Protein-free edema
• Accumulation of transudate in different cavities
• Flabbiness of the skin
• Excessive wrinkling
• vitamin deficiency
• Problem hair, nails
• Loss of teeth
• Stomatitis
• Violation of intestinal motility
• constipation
• Drowsiness
• Decreased immunity
• Susceptibility to depression
• Anemia
• Decreased sexual function
• amenorrhea in women
• Decrease in circulating blood volume
• Lowering blood pressure

Forms and stages of cachexia

The hypothalamic form of cachexia is characterized by a decrease or complete cessation of synthesis, release of peptide y into the blood, which leads to suppression of protein kinase activity, the process of lipogenesis, a decrease in the activity of endothelial lipoprotein lipase, inhibition of fatty acid transport, intensification of catabolism, suppression of anabolism, depletion of fat reserves, which causes an intensive decrease in weight.

With the cachechtin form of exhaustion, frequent emotional stresses are observed, appetite suppression due to excessive production of substances contributing to this, cachechtin production increases, neuropeptide synthesis decreases, anorexia develops, and body weight is rapidly decreasing.

The anorexic form of cachexia is accompanied by malabsorption, an increase in neoplasms, while there is an excessive amount of tumor necrosis factor alpha in the blood, hypoinsulinism, hypocorticism, and a deficiency in the effects of thymus hormones. All these factors lead to rapid weight loss.

Cachexia and its treatment

The treatment of cachexia is based on the elimination of the main disease, that is, the cause that created excellent conditions for the development of the disease. An important role is played by the introduction of measures aimed at restoring nutrition. It is important to provide general care for the patient. As for nutrition, it should contain proteins, fats, vitamins, while preference is given to products that are easily absorbed by the body.

In case of digestive disorders, food absorption, the doctor prescribes polyenzymatic drugs. In severe cases, parenteral administration of a glucose solution, vitamins, electrolytes, protein hydrolysates, amino acid mixtures is used. If necessary, anabolic hormones are used.

Sports play an important role in the treatment of cachexia, since exercise helps increase appetite, and this, as they say, is what the doctor ordered.

cachexia in cancer

Or general atrophy is characterized by loss of body weight, which is the result of loss of fat. Cachexia is manifested in cancer by flabbiness, dry skin, and sharp weight loss. Areas of natural deposition of expendable fat disappear, muscles are depleted and atrophy. The internal organs are significantly reduced in size and lose weight. As the heart shrinks, the coronary arteries become tortuous because their length remains the same. The skin loses its usual color, acquires a gray tint.

What causes cancer cachexia?

• Hypercalcemia syndrome
• Metallic alkalosis
• Plasma cholesterol reduction
• Water retention in the body
• Hyponatremia
• Cushing's syndrome with high blood pressure
• Osteoporosis
• Hormonal activity
• Anorexia
• Weakness in the muscles
• Drowsiness
• Anemia
• Fever
• Increasing energy demand

Irreversible syndrome of loss of muscle and adipose tissue accompanies most patients in the later stages of the malignant process. Cancer cachexia characterized by an unplanned weight loss of more than 10% over the last 12 months of illness. Oncologists very often consider the joint development of anorexia and cachexia. This is associated with a decrease in appetite in a cancer patient and, accordingly, with a decrease in food intake.

What is cancer cachexia?

This term has been known since ancient times. Even Hippocrates described cachexia as a loss of mass in seriously ill patients.

Currently, the progressive decrease in muscle and adipose tissue in cancer patients is commonly called anorexia-cachexia. As everyone knows, anorexia means starvation or a significant reduction in food intake. Cachexia in this case includes the general depletion of the body of a cancer patient.

What is dangerous for life?

The hallmark of this condition is involuntary weight loss. Atrophy of the muscular system is accompanied by loss of appetite, pain and general malaise. In addition, patients gradually become more difficult to perform limb movements.

According to oncological statistics, cachexia is the cause of death in 70% of patients.

Reasons for development

In the last decade, scientists have made significant progress in studying the causes of the development of this condition. It is now known that the key mechanism for the formation of cachexia is increased breakdown of muscle protein along with inhibition of its synthesis.

During numerous experiments on rodents, researchers discovered the existence of a gene that is responsible for muscle atrophy. So, the oncological process, inflammation and other pathologies are capable of activating the atrophy gene through special enzymes.

Manifestations

Signs of pathology develop against the background of the progress of a particular type of cancerous lesion. This process is usually accompanied by the spread of the tumor outside the organ and the formation of multiple metastases.

The main criterion for cachexia is unmotivated more than 3 kg for two months.

The main symptoms of the cachectic state of the body include:

• subfebrile indicators of body temperature;
• gradual increase in pain syndrome;
• decrease in physical activity of the patient;
• fatigue and general malaise;
• apathy, which can be replaced by periods of nervous strain.

Basic Treatments

Traditionally, cancer patients in the terminal stages of neoplasm growth are advised to adhere to the following principles:

1. Dividing the daily diet into a large number of small portions.
2. Most of the food is consumed in the morning.
3. Balanced nutrition in terms of protein, carbohydrate and fat composition.

Therapeutic measures in this period are focused on the return of the cancer patient's appetite:

Corticosteroids:

Back in the 70s, clinical studies proved the effectiveness of corticosteroid hormones in increasing appetite in patients with. For this purpose, some doctors prescribe Dexamethasone.

Progestational agents:

The action of these substances has antiemetic and mass-gathering effects.

Enteral and parenteral nutrition:

They are crushed and easily digestible food ingredients.

Forecast and prevention

To date, this pathology is considered almost incurable. The cachectic state, as a rule, is observed in patients in the terminal phases of oncology. As a result, the prognosis is poor with high mortality rates.

Prevention in this case consists in the timely introduction of hormonal drugs into the course of anticancer therapy. Correction of the hormonal status contributes to the prolongation and quality of life of a cancer patient.

Cachexia in oncology requires a comprehensive and balanced medical approach. Treatment in this case is closely related to the impact on the primary cancer focus.

And diseases of the gastrointestinal tract that occur with syndromes of impaired digestion and absorption of food (chronic enterocolitis, -, condition after gastric resection, gastrectomy), psychogenic, long-term in chronic infectious diseases (tuberculosis, brucellosis, etc.) and purulent processes (abscesses, festering bronchiectasis, osteomyelitis), debilitating (especially nodular), severe, malignant (cancerous K.), metabolic and energy disorders (Metabolism and energy) in endocrine diseases, especially with panhypopituitarism (pituitary K. - see Hypothalamo-pituitary insufficiency ) , adrenal insufficiency, thyroid disease. To. at children is, as a rule, a consequence of a hypotrophy (see. Dystrophy at children ).

K.'s pathogenesis is determined by the disease that caused it, but in all cases it includes profound metabolic disorders with depletion of fat and carbohydrate reserves, increased protein catabolism and a decrease in its synthesis.

Clinically K. is shown by sharply expressed weakness, disability, sharp weight loss. which is often associated with signs of dehydration (Dehydration) , although in some cases hypooncotic (protein-free) edema of the subcutaneous tissue and accumulation of transudate in various body cavities are observed. In severe cases, weight loss can reach 50% or more. patients become pale, or sallow-gray, flabby, wrinkled: the subcutaneous tissue decreases sharply or disappears, often there are signs of vitamin deficiency (Vitamin deficiency) . Trophic changes in hair and nails are noted. Develops , often fall out ; the intestines are disturbed, stubborn ones are often noted. Sexuality decreases, in women it occurs. The volume of circulating blood decreases, usually reduced. Determined, hypoalbuminemia, often also iron- or B 12-deficient. Decreased glomerular filtration in the kidneys.

Content

The result of serious pathologies can be a sharp and significant loss of body weight. This condition is called cachexia and is accompanied by a pronounced deterioration in well-being, requiring urgent medical attention. The most unfavorable prognosis in the absence of treatment is death. Therapy of the disease should be dealt with only by a specialist of the appropriate profile, since there is a high risk of developing concomitant complications.

What is cachexia

A condition characterized by an extreme degree of exhaustion of the body and arising as a result of serious violations of physiological processes is called cachexia. The term is used for abnormalities found in clinical or laboratory tests. In the International Classification Directory of Diseases (ICD-10), cachexia is coded by the symbol R64 and is included in the category R50-R69 “General symptoms and signs”.

Manifestations of cachexia are highly specific - the appearance of the patient changes greatly, the mental state worsens, the vitality decreases. The etiology of the condition is associated with a wide range of pathologies, including cancer and acquired immunodeficiency syndrome (AIDS). In some cases, the patient can provoke the disease on his own by consciously refusing to eat (due to religious beliefs or due to a pathologically critical attitude towards his body).

The reasons

Depending on the factor provoking the disease, cachexia is characterized by various signs. It has not been reliably determined what effect the causative pathologies have on the pathogenesis of the disease, but a number of specific causes that cause exhaustion have been identified. These include:

• a birth process complicated by massive bleeding (a postpartum pituitary infarction is formed in a newborn child, leading to the development of Sheehan's syndrome);
• a decrease in the diameter (stenosis) of the esophagus, which prevents food from entering the stomach;
• violation of the processes of digestion of food and absorption of nutrients (occurs in diseases such as enterocolitis, celiac disease, malnutrition in children);
• poisoning of the body with toxins as a result of a long course of infectious diseases (brucellosis, tuberculosis) or purulent processes (abscesses, progressive osteomyelitis);
• psychogenically caused syndrome of complete lack of appetite (anorexia) or forced starvation;
• insufficiency of the endocrine glands (adrenal glands, thyroid) or the hypothalamic-pituitary system;
• severe form of heart failure;
• uncontrolled use of psychostimulants;
• violations of protein metabolism (amyloidosis);
• oncopathology;
• AIDS;
• secondary respiratory diseases developing against the background of chronic infections (bronchiectasia);
• systemic connective tissue diseases of a diffuse nature (lupus erythematosus, scleroderma, polymyositis).

Symptoms

Manifestations of cachexia vary depending on the type of disease provoking it, but a common and constant symptom is a rapid decrease in body weight (up to 50% of the original). Other common symptoms present in the history of the disease are:

• asthenia (general weakness, impotence, irritability);
• subdepressive state (deterioration of mood, apathy, demotivated behavior);
• low blood pressure;
• muscle hypotension (decrease in muscle tone);
• protein-free edema (due to impaired lymph flow, fluid is removed from the tissues and accumulates in the serous cavities);
• a decrease in the glomerular filtration rate in the kidneys (the passage of fluid through the renal vessels);
• keratinization and drying of the skin (the skin becomes flabby and acquires an unnatural color, wrinkles appear);
• crumbling, loss of teeth;
• frequent dizziness;
• sensation of coldness in the extremities without fever (due to a decrease in the volume of circulating blood);
• the appearance of ulcerative formations in the mouth (stomatitis);
• increased fragility of nails, hair loss;
• severe and prolonged constipation;
• decreased potency in men, amenorrhea (absence of menstruation for 3 or more months) - in women;
• violation of the intestinal microflora, manifested in the form of a deterioration in peristalsis (dysbacteriosis).

In most cases, all or most of the listed symptoms are present, less often the clinical picture is supplemented by atypical phenomena. Severe forms of the disease provoking cachexia or a period of its exacerbation may be accompanied by the addition of the following conditions to the main symptoms:

• amentia (temporary clouding of consciousness, expressed in incoherent speech and movements);
• severe or rudimentary forms of delirium (a mental disorder accompanied by hallucinations and delusions);
• pseudo-paralysis (unreasonably elevated mood, carelessness, committing ridiculous acts).

Degrees

The nature of the pathological changes that occur in the body during exhaustion predetermines the division of the disease into 3 degrees. The expediency of determining the specifics of the disease process is due to differences in treatment regimens. Signs of degrees of cachexia are specific manifestations, which include:

Classification

The structures damaged due to the development of the primary disease predetermine the scenario of the pathological depletion of the body. The main classification feature of cachexia is its etiology. The disease is classified into exogenous depletion (lack of nutrition or a conscious refusal to eat) and endogenous (developing against the background of internal failures that have occurred). There are such forms of pathology:

• Cancer cachexia - diagnosed in patients with malignant tumors of any size. The cause of depletion is the poisoning of the body by the decay products of tumor formations or the excessive accumulation of lactic acid and its salts (lactates). Cachexia in oncological diseases does not develop in all patients (even in the presence of large tumors) and the cause of this phenomenon has not yet been determined.
• Alimentary cachexia - occurs due to a violation of all metabolic processes in the body. This condition can occur due to a prolonged lack of intake of essential nutrients during fasting. The result is muscle atrophy, hormonal disruptions, impaired intellectual activity and the psyche.
• Senile exhaustion is associated with diseases that develop with aging. The natural process of reducing muscle mass (occurring after 50-55 years) does not apply to pathological wasting.
• Cardiac cachexia - disorders of the heart muscle (myocardium) lead to a deterioration in the blood supply to organs, resulting in blood stasis. If this process progresses and becomes severe, further changes occur (an increase in liver size and the number of inflammatory cytokines) that provoke weight loss.
• Cerebral cachexia - develops as a result of damage to brain structures (hypothalamus, diencephalon). This is the most difficult type of disease to treat, characterized by the presence of psychological trauma in the anamnesis of patients.
• Pituitary depletion - the causes of development are congenital or acquired pathologies associated with hormonal failure, expressed in dysfunction of the pituitary gland (anterior part) and hypothalamus (central part). The consequence of violations is a reduction or complete cessation of the production of adenohypophysis hormones (somatotropin, prolactin, gonadotropin, lutropin, etc.)

Complications

In the absence of timely measures taken to normalize metabolic processes, exhaustion reaches an extreme degree and can lead to negative consequences. The most dangerous possible complications of progressive weight loss include:

• dehydration (dehydration) of the body;
• internal bleeding (with peptic ulcer of the stomach or intestines);
• irreversible clouding of consciousness;
• mental disorders (apathetic stupor, chronic asthenia);
• exacerbation of the primary disease;
• sepsis (blood poisoning);
• hypo- and beriberi;
• development of renal and heart failure;
• coma.

Diagnostics

Determining the presence of exhaustion in a patient is not difficult, but a number of diagnostic measures are carried out to determine the cause of cachexia and its severity. After the initial examination, which includes a physical examination and questioning of the patient, the doctor may prescribe one or more of the following types of diagnostic procedures:

• ultrasound examination (ultrasound) of the abdominal organs;
• blood donation for laboratory tests (general, biochemical, hormonal);
• magnetic resonance imaging (MRI) of the brain;
• general urine analysis;
• bacteriological seeding (bakposev) of biomaterial to detect signs of sepsis;
• chest x-ray;
• endoscopic examinations (colonoscopy, hysteroscopy, gastroscopy, esophagogastroduodenoscopy, etc.)

After receiving and deciphering the results of the tests, the specialist determines the tactics of treatment. Often, doctors of several specializations take part in the preparation of a therapy program, which is due to the multifactorial etiopathogenesis of the disease. Specialists qualified in the following areas of medicine can advise on areas of treatment:

• neurology;
• psychiatry;
• endocrinology;
• oncology;
• surgery;
• gastroenterology.

Treatment of cachexia

Exhaustion of the body is a consequence of exogenous or endogenous factors, therefore, in the treatment of pathology, the main attention is paid to the elimination of the causes of the disease state. A mandatory measure of the therapeutic course is the restoration of good nutrition, which should occur gradually and systematically. To normalize appetite and the functioning of the digestive system with cachexia, the following groups of drugs can be prescribed:

Forecast

It is possible to achieve full recovery from exhaustion of the body only if the factors provoking its development are eliminated. The most unfavorable prognosis is in cancer patients - more than 30% of cases are fatal. Not cachexia itself is the cause of death of patients, but the complications accompanying it (skeletal muscle atrophy, disappearance of the fat layer, inhibition of metabolism, etc.).

Timely measures taken to stabilize the state of an emaciated patient reduce the impact of pathology on life expectancy. A depressed psycho-emotional state (subdepression) in the initial stage does not lead to critical psychiatric deviations, and the patient is able to independently seek medical help. To increase the chances of a complete cure, you should follow all the recommendations of doctors, eat well and observe the daily routine. Discuss

Cachexia - causes, symptoms, stages of the disease, diagnosis and treatment methods

- extreme malnutrition associated with oncological diseases. It is manifested by a sharp decrease in body weight, muscle weakness, disability, sleep disorders, pallor and flabbiness of the skin, trophic changes in hair and nails, hypotension, decreased immunity, edema, mental disorders, amenorrhea in women and loss of libido in men. Cancer cachexia is accompanied by disorders of all types of metabolism. Often becomes a direct or indirect cause of death of the patient. It is diagnosed on the basis of anamnesis, external examination data and objective studies. Medical treatment.

General information

Cancer cachexia is a progressive loss of body weight that occurs with malignant neoplasms and is accompanied by neuromuscular weakness, anorexia, disorders of protein, fat, carbohydrate and water-electrolyte metabolism. Cancer cachexia has a pronounced negative impact on the work of all organs and systems. Over time, it becomes the cause of homeostasis incompatible with life. According to various sources, it is the cause of death of 20-50% of patients suffering from oncological diseases. It can occur with tumors of any localization, but is more often diagnosed with lesions of the respiratory and digestive systems. Treatment of cancer cachexia is carried out by specialists in the field of oncology, nutrition, gastroenterology, pulmonology and other fields of medicine (depending on the location of the neoplasm).

The pathogenesis of cancer cachexia

The pathogenesis of this condition is not yet well understood. It is assumed that the main role in the development of cancer cachexia is played by intoxication of the body with the decay products of a malignant neoplasm. Some experts point out that the factor provoking and / or aggravating this syndrome is a secondary infection in the zone of a decaying tumor. It has been established that cancer cachexia in a number of ways differs from exhaustion caused by insufficient intake of nutrients into the body. With cachexia caused by starvation, there is a decrease in the amount of adipose tissue. The metabolic rate decreases, the liver atrophies, protein breakdown slows down. With cancer cachexia, the patient loses both adipose and muscle tissue. The metabolic rate remains normal or increases, the liver increases, protein breakdown becomes more intense.

In addition, cancer cachexia is accompanied by a disorder of all types of metabolism. Carbohydrate metabolism disorders are manifested by a decrease in glucose levels, a decrease in glycogen stores, an increase in gluconeogenesis, and a decrease in insulin sensitivity. Violations of fat metabolism in cancer cachexia are a decrease in the amount of fat, increased lipolysis, a decrease in the activity of lipoprotein lipase, an increase in triglycerides and the breakdown of glycerol. The violation of protein metabolism is evidenced by a negative nitrogen balance and increased protein breakdown, including due to striated muscles.

Cancer cachexia occurs against the background of a decrease in the amount of incoming nutrients and an increase in energy costs. A constant sign of cancer cachexia is an appetite disorder caused by a number of factors, including pain, taste and smell disorders, chemotherapy, radiotherapy and stomatitis, often developing in cancer patients. Other reasons for the development of cancer cachexia are depressive disorder, dysfunction of various organs, nausea, vomiting, growth of tumors of the gastrointestinal tract, compression of the stomach and intestines by neoplasms located in nearby organs.

Increased energy loss in cancer cachexia is due to malabsorption syndrome and diarrhea, which often occur against the background of radiation therapy, chemotherapy, surgical removal of large sections of the gastrointestinal tract, pancreatic neoplasms, carcinoid syndrome, thyroid cancer and gastrinoma. Due to significant protein losses in patients with cancer cachexia, anemia, hypertransferrinemia and hypoalbuminemia occur. Trophic changes in the skin, decreased immunity and limited mobility due to severe weakness cause the development of bedsores and pneumonia.

Classification of cancer cachexia

There are three stages of cancer cachexia:

• Precachexia. Accompanied by impaired appetite, decreased glucose tolerance and other signs of malnutrition in the absence of significant weight loss.
• . Diagnosed with a loss of 5% or more of body weight in the last six months, with a loss of 2% or more of body weight in combination with sarcopenia, or with a decrease in body weight of 2% or more if the body mass index is less than 20 kg/m2.
• Refractory cancer cachexia. It is accompanied by a pronounced deterioration in the patient's condition, lack of response to chemotherapy and radiotherapy, and the ineffectiveness of therapeutic measures to increase body weight.

Symptoms of cancer cachexia

Patients complain of severe weakness, lethargy, fatigue, fever, constipation or diarrhea. The daily rhythm of sleep-wake is disturbed: at night, patients with cancer cachexia suffer from insomnia, during the day they feel sleepy. In women, amenorrhea occurs, in men there is a lack of libido. Mental disorders develop. Many patients with cancer cachexia suffer from depression. Tearfulness, irritability and emotional lability are observed, followed by apathy and indifference. With the progression of the underlying disease, disturbances of consciousness are possible.

An external examination of patients with cancer cachexia reveals exhaustion of varying severity. Sometimes (as a rule - with tumors of the ovaries, uterus or mammary gland, accompanied by hormonal disorders), patients have normal or increased body weight. The skin of patients with cancer cachexia is dry, flabby, grayish or yellowish in color with an earthy tint. There is a deepening of wrinkles, a pronounced deficiency of subcutaneous adipose tissue, fragility of hair and nails, increased hair loss. Protein-free edema, ascites, or hydrothorax may be observed. Hypotension and tachycardia are determined. Stomatitis develops, loosening and loss of teeth is possible. Anemia is determined by blood tests.

Diagnosis of cancer cachexia

The diagnosis of "cancerous cachexia" is established taking into account the anamnesis (presence of cancer), complaints, external examination data, laboratory and instrumental studies. In the process of diagnosis, attention is focused on reducing the amount of food consumed, the predominance of catabolic processes over anabolic ones, pronounced disorders in the function of skeletal muscles (decrease in muscle mass, decrease in muscle strength), changes in the functional abilities of the body and deterioration in the quality of life of a patient suffering from cancer cachexia., endocrinologist, urologist , gynecologist, etc.

Treatment of cancer cachexia

Treatment is symptomatic. Patients with cancer cachexia are prescribed a diet that includes the use of easily digestible foods with a large amount of proteins, fats, trace elements and vitamins. Use drugs to increase appetite and antiemetics. If necessary (with severe exhaustion, impaired swallowing, severe infectious complications), parenteral administration of glucose, amino acid mixtures, vitamins and electrolyte solutions is carried out. In parallel, the underlying disease is treated.

The prognosis is poor in most cases, especially in refractory cancer cachexia. The patient's condition is gradually deteriorating. Disorders of homeostasis are aggravated due to disruption of the activity of various organs and systems and associated infectious complications. With the loss of 30-50% of the protein, a fatal outcome occurs. The immediate cause of death is severe general exhaustion, pneumonia and extensive bedsores. Cancer cachexia kills from 20 to 50% of patients suffering from cancer.