Cancer Cachexia

What is cancer cachexia?

Cancer cachexia is a type of cachexia (wasting syndrome). It’s a common complication of cancer that causes you to lose significant amounts of skeletal muscle and body fat. That weight loss can change your appearance, resulting in feeling self-conscious. Cancer cachexia can affect your quality of life and may affect your ability to receive cancer treatment.

Experts estimate cancer cachexia affects 50% of people with cancer and 75% of people with advanced (Stage IV) cancer and is responsible for 25% of cancer deaths. Cachexia can be present in all types of cancer. But it’s most common in people with the following kinds of cancer:

• Colorectal (colon) cancer.
• Lung cancer.
• Melanoma.
• Pancreatic cancer.

Healthcare providers can’t cure cancer cachexia. But treatment focuses on boosting the amount of food that you eat, with special emphasis on high-protein, high-calorie foods.

Symptoms of cancer cachexia

The most significant symptom of cancer cachexia is losing more than 10% of your total body weight, including muscle mass and fat, over the past six to 12 months. Other symptoms may include:

• Fatigue and weakness: Cancer cachexia can make you feel like you don’t have the strength to work, take care of your family or take care of yourself.
• Muscle loss: Healthcare providers may call this muscle wasting or muscle atrophy.
• Anorexia: In anorexia, you don’t feel hungry and lose interest in eating at all. Anorexia in cancer cachexia is different from the eating disorder anorexia nervosa.
• Anemia: You may develop anemia because your body reacts to inflammation by releasing a protein that affects red blood cell production.
• Frequent infections: Cancer cachexia may affect your immune system so your body can’t fight off infections.

What causes cancer cachexia?

Cancer makes your metabolism speed up so your body needs more of the energy that food provides. At the same time, cancer and cancer treatment can affect your appetite. The result is that you’re eating much less food at the same time your body needs more nutrition. Specific issues that lead to cancer cachexia include:

• Certain cytokines: Cytokines are chemicals that manage how and when your immune system reacts to intruders like viruses. In cancer cachexia, your immune system releases specific cytokines that cause inflammation that speed up how much fat and muscle you lose. The rush of cytokines adds to the inflammation that cancerous tumors cause.
• Cancer symptoms and side effects: Cancer can cause pain, nausea and vomiting, so you eat less. Having cancer may make you feel depressed, which can affect your appetite.
• Cancer treatment side effects: Surgery and treatments like radiation and chemotherapy, and opioids can cause difficulty swallowing, or keep your body from absorbing nutrients.
• Insulin resistance: Insulin resistance is when your muscles and fat don’t react to insulin as they should. Insulin resistance in cachexia may increase muscle loss.
• Increased protein turnover: Protein turnover refers to the way older proteins in your cells are replaced with new proteins. This happens through protein degradation (breaking down proteins). In cancer cachexia, proteins in your cells break down too quickly to be replaced with new proteins. This leads to muscle loss.

Complications of cancer cachexia

The condition can be life-threatening: It’s the primary cause of death in 20% to 25% of people with metastatic solid tumors, like tumors in your lungs or prostate that are spreading to other areas of your body. Other potential complications include:

• Impact on cancer treatment: Your body needs muscle and fat to recover from cancer treatment. Losing fat and muscle can affect your ability to receive cancer treatment.
• Mental health issues: A cancer cachexia diagnosis may mean you only have a few months to live. That knowledge may make you feel anxious and depressed.
• Impact on family and friends: Cancer cachexia can put pressure on your relationships with family and friends. Just like it may be hard for you to see the changes in your body, the people who care for you may become increasingly concerned about your health. Studies show family members often react to loved ones’ cancer cachexia symptoms by urging them to eat, which can create conflict and add to an already stressful situation.

How do healthcare providers diagnose cancer cachexia?

Your oncologist and/or palliative care provider will do a physical examination. They may ask you to complete a questionnaire about your eating habits and do tests to evaluate your overall fitness and muscle strength.

They may order imaging tests like a computed tomography (CT) scan or a dual X-ray absorptiometry (DXA) scan. This test measures the amount of lean tissue in your arms and legs and is a way your oncologist can estimate your muscle mass. Test results will help your oncologist establish the condition stage.

Stages of cancer cachexia

There are three cancer cachexia stages:

• Pre-cachexia: In this stage, you’re losing weight even though you’re eating well. Your weight loss over the past six to 12 months is less than 5% of your overall weight. If you have obesity, your weight loss may not be as noticeable, but tests show metabolic changes that indicate you’re losing muscle along with fat.
• Cachexia: You’ve lost more than 5% of your body weight in the past six to 12 months, or you’ve lost more than 2% of your body weight and your body mass index (BMI) is less than 20kg/m. Tests may show signs of muscle loss and inflammation.
• Refractory cachexia: You’ve lost more than 20% of your usual weight and your BMI is less than 27 kg/m. Your weight loss causes a drastic change in your appearance and you may not be strong enough for cancer treatment. In some cases, cancer treatment stops working.

What are treatments for cancer cachexia?

Your treatment will focus on ways to improve nutrition. For example, your oncology and palliative care teams may recommend that you:

• Eat well: Focus on having frequent small meals and snacks that involve foods that are high in calories, fat and protein. You get more calories by eating small amounts of food. Ask your nutritionist to recommend food choices that help you get the most benefit out of every bite you take.
• Try supplements: Ask your oncologist or nutritionist to suggest nutritional supplements that you can drink or eat in between meals.
• Get some exercise: Light exercise may slow down muscle loss.
• Lean on your team: Your palliative care team can help you with issues like mental health and spiritual support.

Are there medications to treat cachexia?

Not at the moment. While research shows the drug megestrol acetate may improve your appetite so you eat more and gain weight, the drug doesn’t have U.S. Food and Drug Administration (FDA) approval for cancer cachexia treatment. In some situations, your provider may prescribe corticosteroids that you’ll take for a short period of time.

What can I expect if I have cancer cachexia?

That depends on your situation, including the cachexia stage and cancer stage. For example, if you have pre-cachexia, changes in what you eat may slow down how much fat and muscle you lose. Unfortunately, increasing how much you eat can’t stop the loss or restore the muscle and fat you’ve lost.

If you have advanced cancer, cachexia or refractory cachexia, your oncologist may tell you that end of life is near. If you’re receiving treatment for cachexia, your healthcare team is your best resource for information about what you can expect.

What is the life expectancy for someone with cancer cachexia?

Life expectancy will vary. While cancer cachexia typically affects people with advanced cancer, you can develop pre-cachexia symptoms at any cancer stage. In that case, you may live for years with cancer and complications like cachexia. But research suggests that having refractory cancer cachexia reduces cancer survival rates by 30%.