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Cancer cachexia, also known as wasting syndrome, is a condition that occurs alongside many types of cancer and is characterized by muscle wasting, weight loss, depletion of muscle mass, anorexia, fat metabolic disorder, inflammation, gut dysbiosis, and frailty. The muscle wasting associated with cancer cachexia is believed to be caused by the disease causing the immune system to release certain chemicals called cytokines into the bloodstream. These chemical messengers cause inflammation that leads to muscle and fat loss. Cytokines also speed up metabolism, causing the body to burn more calories and break down muscle and fat to get more energy. This can lead to severe weight loss even when eating normally. Cancer cachexia is estimated to occur in up to 80% of people with advanced cancer and can have serious physical and mental health consequences, making everyday activities difficult and impacting the patient's quality of life.
| Characteristics | Values |
|---|---|
| What is it called when cancer causes muscle atrophy? | Cancer cachexia, or cachexia |
| How common is it? | Occurs in up to 80% of people with advanced cancer |
| What causes it? | Inflammation caused by cytokines released by the immune system |
| What are cytokines? | Chemical messengers |
| What do cytokines do? | Cause muscle and fat cells to break down faster than they can be replenished |
| What are the symptoms? | Weight loss, muscle loss, fatigue, loss of appetite, weakness, changes in appearance |
| How is it treated? | Exercise, nutrition, appetite stimulants, inhibitors, and other medicines |
| What is the prognosis? | Can lead to death, often due to heart or respiratory failure related to muscle loss |
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What You'll Learn
Cancer cachexia
Cachexia, a wasting syndrome, leads to loss of skeletal muscle and fat, and is estimated to occur in up to 80% of people with advanced cancer. It can make individuals feel tired and unable to perform their daily activities. It is most common in people with advanced pancreatic and lung cancer but also frequently occurs in people with other types of cancer, including head and neck, colorectal, ovarian, and liver cancers. The current definition of cancer cachexia is a loss of 5% or more of body weight over the preceding 6 months, accompanied by other symptoms, including fatigue and reduced strength.
The side effects of cancer and its treatments might cause problems with eating, digestion, and weight. Cancer cachexia is more than a loss of appetite; it involves changes in the way the body uses proteins, carbohydrates, and fats. People with cachexia burn calories faster than usual and may have insulin resistance, where the body cannot use glucose from the blood for energy, leading to weight loss. This can happen even with normal eating habits. Cachexia is very different from general weight loss and cannot be reversed with nutritional support alone.
There are currently no effective treatments for cachexia. However, researchers have launched clinical trials to test exercise- and nutrition-based treatments. In experimental cancer cachexia, certain drugs have been shown to restore myogenesis and attenuate muscle depletion and weakness.
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Cytokines and inflammation
Cancer cachexia, a wasting syndrome that leads to loss of skeletal muscle and fat, is estimated to occur in up to 80% of people with advanced cancer. It is a complex change in the body, causing weight loss despite eating normally. The widespread inflammation that often accompanies cancer is thought to be the primary force behind cachexia. This inflammation causes disruptions in how muscle and fat cells make and use energy, known as metabolism.
Cytokines are small secreted proteins that act as chemical messengers in the immune system. They are released by the immune system in response to invading pathogens to stimulate, recruit, and proliferate immune cells. Cytokines include interleukins (IL), chemokines, interferons, and tumor necrosis factors (TNF). They are also released by the body's cells in response to threats or tissue damage. They signal to the immune cells, telling them where to go and what to do. For example, cytokines can direct immune cells toward an infection site so they can fight germs. They can also heighten or lessen the processes associated with inflammation.
Inflammation influences both the levels and behavior of cytokines, which can cause skeletal muscle to wither and dampen the desire to eat, further robbing the body of the fuel it needs. Cytokines are involved in the initiation and persistence of pathologic pain. Certain inflammatory cytokines in the spinal cord, dorsal root ganglion (DRG), injured nerve or skin are associated with pain behaviors and the generation of abnormal spontaneous activity from injured nerve fibers or compressed/inflamed DRG neurons.
There are both pro-inflammatory cytokines and anti-inflammatory cytokines. Pro-inflammatory cytokines trigger or heighten inflammation and relay messages that coordinate the body's immune response to fend off attackers, like germs. The key pro-inflammatory cytokines are IL-1, IL-6, and TNF-α. IL-6 is a pleiotropic cytokine that not only affects the immune system but also acts in other biological systems and many physiological events, such as regulating cell growth, gene activation, proliferation, survival, and differentiation. Anti-inflammatory cytokines stop or lessen inflammation. They relay messages that prevent an excessive immune response that can lead to tissue damage.
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Insulin resistance
Cancer cachexia is a severe condition that frequently accompanies the development of many types of cancer. It is a wasting syndrome that leads to a loss of skeletal muscle and fat, causing weight loss despite eating normally. Cachexia is estimated to occur in up to 80% of people with advanced cancer. It can cause severe physical and mental health struggles, making everyday activities difficult and causing worry, stress, anxiety, and mental anguish.
There is a link between insulin resistance and cancer. Insulin resistance and related increased plasma insulin levels (hyperinsulinemia) may contribute to tumor initiation and progression. Hyperinsulinemia can stimulate cell proliferation and inhibit cell death, providing more opportunities for cancer to develop. Additionally, insulin resistance can lead to inflammation, which can also promote a protumorigenic environment.
Cancer and its treatments can cause insulin resistance. Cancer patients may take medications that elevate blood sugar levels, and the widespread inflammation associated with cancer can disrupt metabolic balance, affecting how muscle and fat cells use energy. This can result in muscle wasting and severe weight loss.
To manage insulin resistance in cancer patients, it is important to control blood sugar levels through lifestyle changes such as a plant-based diet, exercise, and weight management. These proactive steps can help reduce the risk of health complications and improve overall health.
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Exercise as a treatment
Cancer cachexia, a wasting syndrome that leads to loss of skeletal muscle and fat, is estimated to occur in up to 80% of people with advanced cancer. It is associated with serious clinical consequences such as physical weakness, fatigue, and an inability to eat. It is also thought to directly cause up to 30% of cancer deaths, often due to heart or respiratory failure related to muscle loss.
Exercise is the only recommended behavioral treatment for cancer cachexia. It is considered beneficial in decreasing protein degradation, which reduces various types of atrophy and improves skeletal muscle function. It is also believed to reduce treatment-related toxicity by enhancing blood flow, blood sugar regulation, and the release of endorphins. Moreover, exercise has systemic anti-inflammatory effects, while conventional cancer care causes inflammation in the body.
The type of exercise recommended for cancer patients depends on various factors, including the type of cancer, the treatments being received, the side effects experienced, and the patient's level of fitness. For instance, patients whose cancer has not spread beyond its initial site may be advised to engage in regular aerobic exercise, such as walking, jogging, or cycling, and strength training, such as lifting weights or using resistance bands. Aerobic exercise helps strengthen the heart and lungs, while resistance exercise strengthens the muscles. Both types of exercises can work together to help cancer patients maintain their health and well-being.
It is important to note that exercise programs for cancer patients should be carefully implemented, considering factors such as chronic fatigue, anemia, cardiac dysfunction, and other comorbidities that may limit exercise capacity. Patients should consult with their doctors to determine the appropriate exercise plan for their specific needs and conditions. Starting slowly and listening to one's body are crucial, and adjustments can be made based on energy levels and tolerance. For example, if energy levels are low, the duration or intensity of the exercise can be modified accordingly.
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Appetite stimulants
Cancer cachexia, a wasting syndrome that leads to the loss of skeletal muscle and fat, occurs in up to 80% of people with advanced cancer. It is associated with severe weight loss, weakness, fatigue, and a loss of appetite. This loss of appetite, or cancer-associated anorexia, is prevalent in patients with advanced cancer and is distressing to both patients and their families. It is also associated with poorer outcomes in patients with advanced cancer.
There are several treatments for poor appetite, including nutritional support and appetite stimulants. Nutritional support can be administered intravenously, through total parenteral nutrition, or directly into the gastrointestinal tract through enteral nutrition. Appetite stimulants may help patients maintain adequate calorie and nutrient intake from food sources.
Marinol is an appetite stimulant that has been proven to reduce chemotherapy-induced nausea and vomiting in cancer patients. In a study of 139 patients with anorexia and weight loss, Marinol significantly increased appetite after 4 weeks. Another drug, Anamorelin, mimics the appetite-regulating hormone ghrelin, which is found in the stomach lining, and may help people with cachexia. Megestrol acetate, or Megace, is a progesterone or steroid hormone that improves appetite in patients with advanced cancer. It is FDA-approved for the palliative treatment of advanced breast and endometrial cancer. However, it is associated with some side effects, such as an increased risk for thrombophlebitis and the suppression of some endocrine functions.
Corticosteroids are another class of agents that have been extensively studied for use as appetite stimulants. While they are among the earliest medications used in symptom palliation, they do not appear to improve the global quality of life or survival of patients.
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Frequently asked questions
Cachexia, also known as wasting syndrome, is a condition that occurs alongside many types of cancer. It is characterised by weight loss, depletion of muscle mass, anorexia, fat metabolic disorder, inflammation, gut dysbiosis, and frailty.
Cachexia is caused by the immune system releasing certain chemicals called cytokines into the bloodstream. These chemical messengers cause inflammation, leading to muscle and fat loss. Cytokines also speed up metabolism, causing the body to burn more calories.
There is currently no single treatment plan or medicine that can cure cachexia. However, researchers are working on understanding the causes and finding new ways to treat it. Some medications, such as appetite stimulants, may help manage symptoms.
