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Cancer cachexia, or simply cachexia, is a wasting syndrome that leads to the loss of skeletal muscle and fat. It is estimated to occur in up to 80% of people with advanced cancer, depending on the type of cancer and how well the patient responds to treatment. Cachexia is caused by the cancerous cells releasing certain chemicals called cytokines into the bloodstream, which cause inflammation that leads to muscle and fat loss. The chemicals may also speed up the patient's metabolism, causing severe weight loss even if the patient is eating normally. Cachexia can cause significant mental and emotional distress for both patients and their caregivers, as it can make patients look like they are wasting away.
| Characteristics | Values |
|---|---|
| What is it called when cancer causes muscle loss? | Cachexia, a wasting syndrome |
| How common is it? | Occurs in up to 80% of people with advanced cancer |
| What are the symptoms? | Loss of fat and muscle mass, decreased appetite, inflammation, fatigue, loss of muscle strength, drastic and unintended weight loss |
| What causes it? | Cancer causes the immune system to release certain chemicals called cytokines into the bloodstream. These cause inflammation and speed up metabolism, leading to muscle and fat loss. |
| What are the risk factors? | Type of cancer, stage of cancer, and response to treatment |
| Can it be treated? | There is no single treatment plan or medicine to cure cachexia. A team approach is recommended, including physical therapy, occupational therapy, and nutritional support. |
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What You'll Learn
Cachexia: a wasting syndrome causing muscle loss
Cancer can cause muscle loss, and this condition is called cachexia, a wasting syndrome that leads to the loss of skeletal muscle and fat. Cachexia is estimated to occur in up to 80% of people with advanced cancer, depending on the cancer type and the patient's response to cancer treatment. Cachexia can cause significant mental and emotional distress for both patients and caregivers.
Cachexia is a chronic illness that weakens the body and makes it waste away. The main symptom of cachexia is the loss of fat and muscle. Other symptoms include decreased appetite, inflammation, fatigue, and loss of muscle strength. People with cachexia may experience a lack of interest in food and exhaustion from eating. They may also experience physical inactivity, making it hard for them to do everyday activities and tasks they previously did routinely, such as walking, climbing stairs, bathing, or doing chores.
The exact cause of cachexia is not fully understood, but it is believed to be related to the immune system's response to cancer. Cancer causes 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, making the body burn calories faster. Additionally, studies have shown that factors released by the tumour block muscle stem cells from differentiating into muscle cells, leaving them unable to repair cachectic muscle fibres.
There is currently no single treatment plan or medicine that can cure cachexia. However, researchers are actively studying the condition and testing new treatments. A team approach is recommended to address the symptoms of cachexia, which may include referrals to oncology dietitians, physical therapists, occupational therapists, and social workers.
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Cytokines: chemicals that cause inflammation and muscle loss
Cancer patients often experience muscle loss, a condition known as cachexia, which affects up to 80% of people with advanced cancer. Cachexia causes severe weight loss, including the loss of fat and skeletal muscle mass.
Scientists have proposed that cancer causes the immune system to release certain chemicals, known as cytokines, into the blood, which in turn causes inflammation and muscle loss. Cytokines are typically classified according to their inflammatory properties. Inflammation influences both the levels and behaviour of cytokines, which have ripple effects throughout the body that can cause skeletal muscle to wither (sarcopenia) and suppress the desire to eat (anorexia).
Cytokines are also associated with muscle damage and repair. Multiple cellular and molecular processes are activated following skeletal muscle damage to restore normal muscle structure and function. These processes typically involve an inflammatory response, which can result in prolonged inflammation and further muscle damage, or its active termination and the promotion of muscle repair and regeneration. A crucial balance between pro-inflammatory and anti-inflammatory cytokines appears to attenuate an excessive inflammatory reaction, prevent muscle fibrosis, and promote the regenerative process.
Additionally, certain types of exercise can inflict significant physiological stress, which can lead to an inflammatory response and the release of cytokines. IL-6, for example, has been identified as an essential regulator of muscle stem cell-mediated hypertrophy. IL-6 deficient mice exhibit severe muscle atrophy, and loss of IL-6 results in proliferation and migration defects in myoblasts.
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Tumour-induced muscle injury and regeneration
Cancer is associated with muscle loss, a condition known as cachexia, which affects up to 80% of people with advanced cancer. Cachexia causes severe weight loss, including the loss of fat and skeletal muscle mass. It can lead to physical and mental health struggles, impacting everyday activities and quality of life.
Skeletal muscle regeneration is a complex process that relies on various cell types, signalling molecules, architectural cues, and physicochemical properties. One critical aspect is the role of stem cells, specifically muscle-derived stem cells (MDSCs) and induced pluripotent stem cells (iPSCs). These cells have been investigated for their potential in skeletal muscle regeneration and transplantation for muscle injury treatment.
Macrophages, particularly M1 and M2 subtypes, are essential in muscle regeneration. M1 macrophages reduce collagen production and stimulate myoblast proliferation, while M2 macrophages increase collagen production and promote myoblast differentiation and fusion to form new muscle fibres. The timely activation and coordination of these macrophage subtypes are crucial for effective muscle regeneration with minimal scarring.
Biomaterials, such as biological scaffolds, are also used to promote skeletal muscle regeneration. These scaffolds provide structural and biochemical support, facilitating the repair of muscle loss and enhancing myogenic precursor cell survival and migration. Additionally, acellular biomaterials can be designed to release bioactive molecules, attracting and stimulating cells to infiltrate the injury site and induce muscle regeneration.
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Insulin resistance: cells in muscles don't respond well to insulin
Cancer patients often experience muscle loss, which can be caused by cachexia, a wasting syndrome that affects up to 80% of people with advanced cancer. Cachexia causes severe weight loss, including the loss of fat and skeletal muscle mass. This can lead to physical and mental health struggles, making everyday activities difficult and causing worry, stress, and anxiety.
Insulin resistance is a condition where the body, specifically the cells in the muscles, fat, and liver, do not respond appropriately to insulin. Insulin is a crucial hormone produced by the pancreas and is responsible for regulating blood sugar levels by facilitating the movement of glucose from the blood into cells, where it can be used for energy. When cells do not respond correctly to insulin, they cannot efficiently utilise glucose for energy or storage. This results in elevated blood glucose levels, known as hyperglycemia, which, over time, can lead to prediabetes and Type 2 diabetes.
In the context of cancer, cachexia can lead to insulin resistance. The immune system releases certain chemicals, called cytokines, into the blood, causing inflammation. Cytokines contribute to muscle and fat loss and may increase metabolism, leading to severe weight loss even with a normal diet. This cytokine-induced inflammation and insulin resistance can trigger the release of specific cytokine hormones, including interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-15 (IL-15). These circulating factors can further influence obesity, inflammation, and insulin resistance.
Additionally, physical inactivity, certain medications, and food choices can contribute to insulin resistance. A lack of physical activity reduces the body's sensitivity to insulin, while highly processed foods, high in carbohydrates and saturated fats, have been linked to the condition. Furthermore, specific medications, such as steroids, blood pressure medications, and HIV treatments, are known to induce insulin resistance.
Understanding the link between cancer, muscle loss, and insulin resistance is crucial for developing effective treatments for cachexia and improving the quality of life for cancer patients. Researchers are actively investigating these complex relationships to identify potential therapeutic targets.
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Treatment: physical therapy, medication, and nutritional support
Muscle loss is a common feature of cancer cachexia, a wasting syndrome that affects people with cancer. It is characterized by dramatic weight loss, muscle wasting, loss of appetite, and physical deterioration. The prevalence of muscle loss in cancer patients ranges from 16% to 40%, depending on the type of cancer and the stage of the disease.
The treatment of cancer-induced muscle loss involves a multimodal approach, including physical therapy, medication, and nutritional support:
Physical Therapy: Exercise training, tailored to the cancer patient's capacity, can help boost the anabolic effects of nutritional support and prevent the negative consequences of physical inactivity. However, it is important to note that in some cases, cancer patients may experience a decrease in muscle strength due to the disease itself or as a side effect of chemotherapy, which can further limit their physical activity and exacerbate muscle loss.
Medication: Several promising drugs have been developed and some have reached the clinical trial phase. These pharmacological interventions aim to target the molecular mechanisms underlying cancer-related muscle wasting, such as increased muscle protein degradation and mitochondrial dysfunction.
Nutritional Support: Nutritional interventions are crucial in preventing and treating muscle loss. Adequate nutritional support should be provided early in the diagnosis and treatment process to slow the wasting process and stabilize muscle mass and body weight. This includes ensuring proper energy and nutrient intake, which can be achieved through nutritional counselling, oral supplements, and artificial nutrition. Specifically, high-protein formulas enriched with leucine, specific oligosaccharides, and fish oil have been found to stimulate muscle protein anabolism in advanced cancer patients. Additionally, meeting adequate water intake requirements may also support protein anabolism.
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Frequently asked questions
Cancer cachexia is a chronic illness that causes a person to waste away. It is a wasting syndrome that leads to the loss of skeletal muscle and fat. It is estimated to occur in up to 80% of people with advanced cancer.
Cachexia is caused by a variety of factors. One reason is that cancer causes the immune system to release certain chemicals called cytokines into the bloodstream, which cause inflammation that leads to muscle and fat loss. Cytokines also speed up metabolism, making the body burn calories faster.
The main symptom of cachexia is the loss of fat and muscle. Other symptoms include decreased appetite, inflammation, fatigue, and loss of muscle strength.
Researchers are still trying to understand what causes cachexia and find new ways to treat it. Currently, there is no single treatment plan or medicine that can cure cachexia. A team approach is best to address the symptoms, which may include physical rehabilitation or physical therapy.
