Wasting Syndrome or Cancer Cachexia

Wasting Syndrome, or cancer cachexia, is a serious symptom of cancer. Cancer patients often appear malnourished and freqently have dropped a good bit of weight in a very short period of time. Wasting syndrome is used to describe the involuntary weight loss of more than 10% of a person's body weight. The condition causes significant loss in fat and muscle tissue.

Wasting Syndrome causes body fat and vital muscle mass to deteriorate. Some forms of cancer cause wasting early in their progression, such as stomach and gastrointestinal cancers where food cannot be fully digested and absorbed into the body. However it is a fact that nearly 80% of patients with advanced cancers suffer from Wasting Syndrome towards the end of their course.

People suffering from wasting syndrome often experience tiredness and fatigue as well as general malaise and a loss of enthusiasm for life. They commonly have a hard time enduring prolonged sessions of cancer treatments such as chemotherapy and radiation because they no longer have the strength it takes to battle them. This can make beating cancer tough because the patient’s strength is required to withstand scheduled treatments.

The common symptoms of Wasting Syndrome include nausea and vomiting, a loss of appetite, mouth ulcers, and a dry mouth that can make it difficult or almost impossible to swallow. Many patients report that food starts to taste metallic and so they no longer have the desire to eat. Long term it can also cause anemia and liver problems because of the lack of nutrients entering the body. They symptoms may be alleviated during a break in the treatment, but even with renewed appetitie and with parenteral feeding the weight loss associated with severe Wasting Syndrome sometimes is not fully reversed.

Wasting Syndrome is characterized by the loss of at least ten percent of normal body weight without an obvious cause. The weight loss is caused by depletion of muscle just as much as the loss of fat. In other words, someone with extreme nausea and vomiting that causes weight loss does not necessarily have Wasting Syndrome. It has to be vital muscle that has contributed to the drop of at least ten percent in body weight.

When a patient has lost substantial body weight and muscle and is weakened, the chances of responding to chemotherapy are greatly reduced. When patients do take their chemotherapy treatments, they are also more susceptible to other toxic side effects and illnesses. Wasting Syndrome can actually allow an onset of shingles. When the body is weakened, the ability of the immune system is reduced and the body is less able to fight off these toxins and illnesses because the immune system is compromised.

The causes of Wasting Syndrome are thought to be biological as much as a side effect of cancer treatment. Cancerous tumors cause the immune system to release cytokines and other cytotoxic molecules, causing the immune system to respond. Cytokines such as Tumour Necrosis Factor (TNF) can cause the body to accelerate the breakdown of fat and decrease the storage of fat from food. Other metabolic products of tumours and the highly active immune system causes increased loss of muscle and decreased muscle synthesis.A number of factors contribute to wasting syndrome - inadequate food intake, malabsorption, altered metabolic rate, and opportunistic infections.

Inadequate food intake may be due to low appetite. Low appetite is common in mesothelioma patients. Chemotherapy drugs often cause nausea, vomiting, and changes in the smell or taste. Chemotherapeutic agents have been associated with subsequent weight loss. The anxiety and depression that accompany degenerative diseases can also cause profound loss of appetite. Inadequate food intake may also be a result of opportunistic infections in the mouth and throat that cause ulcers and lesions causing painful or difficult swallowing.

Malabsorption refers to poor nutrient uptake in the gut. Another cause could be damage in the intestinal lining of the gut caused by opportunistic parasitic and bacterial infections. Absorption of nutrients occurs in the villi, finger-like protrusions that line the intestinal wall; the presence of infection can damage these structures resulting in impaired absorption of nutrients.

Both shingles and wasting syndrome can be fatal if left untreated and in some cases, they can be more fatal than the cancer itself.

Treatments

There is no standard treatment for wasting syndrome. To help increase food uptake, drugs that reduce nausea and vomiting have been used. Liquid nutritional supplements are given to patients who have difficulty eating solid food. Appetite stimulants including Megace® and Marinol® have also been used.

Nutritional supplements have been used to provide easy-to-absorb nutrients. Non-prescription anti-diarrhea drugs such as loperamide are used to relieve gastro-intestinal irritation. Antibiotics and anti-parasitic drugs are also used to treat opportunistic infections.

Testosterone and other anabolic steroids when combined with exercise appear to be effective in treating weight loss by increasing muscle mass. The use of steroids has been reported to improve quality of life in cachexia patients. Human growth hormone (HGH) has also been used to help patients gain muscle mass. Like steroids, HGH does not correct the metabolic process of wasting; it treats the condition through other hormonal changes.

Many drugs have been studied to correct the metabolic process in wasting syndrome. One is thalidomide which, in clinical trials, has been found to suppress the production of tumor necrosis factor in the body. However, it has not yet been approved by the Food and Drug Administration for this purpose.

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