gms | German Medical Science

For patients with cancer or hematological malignancies exist a lot of factors to loose weight and become malnourished. One cause is the tumor itself and his anatomical location, especially when located in the head and neck area or in the upper gastro-intestinal tract. Cancer of the larynx or oral cavity are responsible for decrease of daily food intake e.g. by hamper swallowing; a structure or obstruction of the esophagus leads to a decrease of calorie intake. Other tumors like brain cancer have nausea and vomiting as clinical symptoms. Gastrointestinal symptoms like vomiting or a gut obstruction up to an ileus can be caused by a cancer of the stomach, the bowels or by Ascites due to gynecology tumors (e.g. ovarian cancer) or urogenital tumors (bladder, prostate). But not only by causing local problems the cancer is the main reason for malnutrition. The tumor is producing mediators, which are the reasons for tumor-cachexia like cytokines: tumor necrosis factor alpha (TNF -a), Interferon gamma (INF-g), inter-leukin 1 & 6 (IL 1, 6), hormones: catecholamine, glucocorticoids, glucagon insulin and tumour specific proteins: Proteolysis inducing factor (PIF), Lipid mobilizing factor (LMF). They are responsible for loss of weight or reduced weight gain, even in the case of proper nutrition. On the other hand, if an organ is destroyed by cancer his function is reduced and especially in pancreas carcinoma an exocrine and endocrine insufficiency is induced. The treatment of the cancer as well is responsible for decreased food intake, due to the operation procedure and the narcotics required for anesthesia; in case of radiotherapy the destruction of the mucosa in the mouth or esophagus is reducing appetite and food intake. Mucositis and stomatitis, as well side effects of chemotherapy, can be treated by opioids, which again lead to nausea and vomiting or constipation as there main side effects with a consecutive weight loss. Beside local mucosa damage chemotherapy is causing nausea, vomiting and loss of taste or taste disturbances, which impair the patient. Further, the injury of the mucosa barrier in the gastrointestinal tract leads to infections causing again by themselves (e.g. herpes mucositis) or by the anti-infective treatment (antibiotics) a loss of appetite and decrease of nutrition. All these above mentioned factors lead in a cancer patient to malnutrition Caregivers should be aware of these, to recognize patient at risk and start nutrition early.