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Kris 307 > Cancer Cachexia > Flashcards

Cancer Cachexia Flashcards

1
Q

What are the effects of malnutrition and weight loss caused by altered metabolism and reduced intake in cancer?

A
  • Decreased quality of life
  • Decreased response to treatment
  • Decreased survival
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2
Q

What are the benefits of assessing nutrition status in individuals with cancer?

A
  • Early identification of patients at risk allows for early intervention
  • Improves patient well-being, survival, immune function, and reduced morbidity
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3
Q

Define cachexia.

A
  • A complex metabolic syndrome ASSOCIATED with underlying illness and characterized by loss of muscle with or without loss of fat mass
  • The prominent feature is weight loss
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4
Q

What is the difference between cachexia and cancer?

A

Cachexia is a syndrome, while cancer is a disease

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5
Q

What is a syndrome?

A

Groups several conditions together, and may not be diagnosed as easily

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6
Q

What leads to muscle wasting in cancer patients?

A
  • Inflammation
  • Insulin resistance
  • Hypogonadism
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7
Q

What leads to fat loss in cancer patients?

A
  • Anorexia

- Inflammation

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8
Q

What are consequences of muscle wasting?

A
  • Increased fatigue
  • Increased treatment-induced toxicity
  • Decreased host response to tumours
  • Decreased performance status
  • Decreased survival
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9
Q

What is sarcopenic-obesity?

A

Obesity with depleted muscle mass

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10
Q

What leads to an increased treatment-induced toxicity in cancer patients with muscle wasting?

A

The drugs are designed based on body surface

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11
Q

What is the overall prevalence of cancer cachexia?

A

50 to 80%

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12
Q

Which cancers have a more frequent prevalence of cancer cachexia?

A
  • Upper gastro-intestinal cancer: 80%
  • Upper gastric and pancreatic cancer: 83-87%
  • Head-and-neck cancers render food intake more complicated
  • Lung cancer: 60% (altered metabolism)
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13
Q

What are the two main components of the onset of cachexia?

A
  • Metabolic change (hypercatabolism and hypoanabolism)

- Reduced food intake

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14
Q

Differentiate hypercatabolism and hypoanabolism.

A
  • Hypercatabolism: increased protein degradation

- Hypoanabolism: less response to anabolic stimuli

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15
Q

Differentiate primary and secondary anorexia.

A
  • Primary: driven by physiological changes due to illness itself
  • Secondary: secondary to the treatment of the disease (chemotherapy, radiotherapy)
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16
Q

What is sarcopenia?

A
  • Decreased muscle mass, which is typically associated with aging
  • May be observed despite a lack of weight change
17
Q

How does the resting energy expenditure differ between starvation and cachexia? What does that induce?

A
  • Starvation reduces REE
  • Cachexia increases REE
  • The loss of weight is more rapid in cachexia than in starvation
18
Q

Why is it so important to diagnose cachexia early on?

A

Because nutritional support provided during the refractory period (last 3 months before death) is not fruitful

19
Q

Differentiate positive and negative acute phase proteins.

A
  • Positive: plasma concentrations increase by over 25% during stress
  • Negative: plasma concentrations decrease by over 25% during stress
20
Q

Which protein is largely measured to indicate a positive acute phase response?

A

C-reactive protein

21
Q

What is the acute phase response modulated by?

A

Cytokines

22
Q

What pro-inflammatory cytokines are found in cancer?

A
  • TNF-a
  • IL-1
  • IL-6
  • IFN-gamma
23
Q

What are the effects of cytokines on skeletal muscle wasting?

A
  • Anorexia (reduced substrate supply)

- Direct catabolic effect on muscle

24
Q

What are the effects of cytokines on the liver?

A
  • Increase in urinary nitrogen loss (because of increased substrate demands)
  • Increase in acute phase proteins
25
Q

What components of energy expenditure does cancer cachexia change?

A
  • Increases resting energy expenditure
  • Decreases thermic effect of feeding
  • Decreases physical activity energy
26
Q

Cancer cachexia is a (hypo/hyper)metabolic syndrome.

A

hypermetabolic (spend less than 600 calories less than healthy individuals)

27
Q

What are metabolic alterations in cancer cachexia?

A
  • Decreased responsiveness to anabolic factors
  • Increased concentration of catabolic factors
  • Mobilization of lipids from adipose tissue stores
  • Glucose is the preferred fuel for tumours
  • Insulin resistance
  • Increased gluconeogenesis
  • Increased synthesis of acute-phase proteins
28
Q

What are the three pathways of proteolysis?

A
  • Lysosomal (caspases)
  • Calcium-dependent (calpains)
  • ATP-dependent ubiquintin-proteosome
29
Q

What is the link between ubiquintination and inflammation?

A
  • Inflammatory cytokines (TNF-a and IL-1) increases the expression of genes encoding UbqE3
  • Induces a greater quantity of proteolysis
30
Q

What source of energy do tumours feed on? What does it produced?

A
  • Glucose
  • Produces lactate
  • Recycled via the Cori cycle
31
Q

What may early satiety result from?

A
  • Reduced GI motility
  • Increase in gastric emptying
  • Opioid analgesics
32
Q

What assessment methods are used to identify the severity of cancer cachexia?

A
  • Analysis of the presence of anorexia
  • Catabolic drive (C reactive protein)
  • Muscle mass and strength
33
Q

What are the three main aspects of treating cancer cachexia?

A
  • Nutritional counselling
  • Exercise
  • Pharmacological treatment
34
Q

What are the goals of therapy to cancer cachexia?

A
  • Stabilizing weight, and attempt to increase lean body mass
  • Predispose to a better response to radio or chemotherapy
  • Increase immunocompetence
35
Q

What route of feeding should be used?

A

Oral

36
Q

When would you use enteral feeding?

A

Obstructions, gastric atony, or limited absorptive capacity

37
Q

When is parenteral nutrition not recommended?

A

Advanced cancer patients receiving chemotherapy, nor the advanced stages of cancer cachexia

38
Q

What is a promising nutrition therapy for cancer cachexia? Why?

A
  • Omega-3 fatty acid

- Anti-inflammatory effects and anabolic properties

39
Q

What has the best chance of successfully treating cancer cachexia?

A
  • Physical exercise
  • Pharmacological agents
  • Individual nutritional counselling
  • Early intervention

Kris 307 (19 decks)

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