Cancer kakheksiya – the extreme exhaustion arising at oncological diseases. It is shown by sharp decrease in body weight, muscular weakness, working capacity violation, frustration of a dream, pallor and flabbiness of skin, trophic changes of hair and nails, hypotonia, decrease in immunity, hypostases, mental disorders, amenorey at women and loss of a libido at men. The cancer kakheksiya is followed by violations of all types of exchange. It becomes frequent a direct or indirect cause of death of the patient. It is diagnosed on the basis of the anamnesis, data of external survey and objective researches. Drug treatment.
Cancer kakheksiya – the progressing loss of body weight arising at malignant new growths and which is followed by neuromuscular weakness, appetite violation, disorders of proteinaceous, fatty, carbohydrate and water and electrolytic exchange. The cancer kakheksiya exerts the expressed negative impact on work of all bodies and systems. Over time becomes the reason of violations incompatible with life of a homeostasis. According to various data, 20-50% of the patients having oncological diseases are a cause of death. Can arise at tumors of any localization, however it is more often diagnosed at damages of a respiratory and gastrointestinal tract. Treatment of a cancer kakheksiya is performed by experts in the sphere of oncology, dietology, gastroenterology, pulmonology and other fields of medicine (depending on localization of a new growth).
Pathogenesis of a cancer kakheksiya
The pathogenesis of this state is still insufficiently studied. It is supposed that the main role in development of a cancer kakheksiya is played by organism intoxication products of disintegration of a malignant new growth. Some experts specify that the factor provoking and/or aggravating this syndrome is the secondary infection in a zone of the breaking-up tumor. It is established that the cancer kakheksiya on a number of signs differs from the exhaustion caused by insufficient intake of nutrients in an organism. At the kakheksiya caused by starvation reduction of amount of fatty tissue is noted. Level of a metabolism decreases, the liver atrophies, disintegration of protein is slowed down. At a cancer kakheksiya of the patient loses both fatty, and muscular tissue. Level of a metabolism remains normal or increases, the liver increases, disintegration of protein becomes more intensive.
Besides, the cancer kakheksiya is followed by frustration of all types of exchange. Violations of carbohydrate exchange are shown by decrease in level of glucose, reduction of stocks of a glycogen, strengthening of gluconeogenesis and decrease in sensitivity to insulin. Violations of fatty exchange at a cancer kakheksiya consist in reduction of amount of fats, strengthening of a lipoliz, decrease of the activity of a lipoproteidlipaza, increase in level of triglycerides and disintegration of glycerin. Violation of proteinaceous exchange is demonstrated by negative nitrogenous balance and strengthening of disintegration of proteins, including – at the expense of cross-striped muscles.
The cancer kakheksiya proceeds against the background of reduction of amount of the arriving nutrients and increase in power expenses. A constant sign of a cancer kakheksiya is the disorder of appetite caused by a number of factors including – a pain syndrome, flavoring and olfactory violations, chemotherapy, radiotheraphy and the stomatitis which is often developing at oncological patients. Depressive frustration, violation of functions of various bodies, nausea, vomiting, growth of tumors of digestive tract, a sdavleniye of a stomach and intestines are the new growths located in nearby bodies other reasons of development of a cancer kakheksiya.
Increase in power losses at a cancer kakheksiya is caused by a syndrome of the broken absorption and diarrhea which often arise against the background of radiation therapy, chemotherapy, surgical removal of considerable sites of digestive tract, new growths of a pancreas, a kartsinoidny syndrome, cancer of a thyroid gland and a gastrinoma. Because of considerable losses of protein patients with a cancer kakheksiya have an anemia, a gipertransferrinemiya and a gipoalbuminemiya. Trophic changes of skin, the decrease in immunity and restriction of mobility caused by sharp weakness become the reason of development of decubituses and pneumonia.
Classification of a cancer kakheksiya
Allocate three stages of a cancer kakheksiya:
- Prekakheksiya. Is followed by appetite violations, decrease in tolerance to glucose and other symptoms of exhaustion in the absence of considerable loss of weight.
- Cancer kakheksiya. It is diagnosed at loss of 5 or more percent of body weight for the last half a year, at loss of 2 or more percent of body weight in combination with a sarkopeniya or at decrease in body weight by 2 or more percent if the index of body weight makes less than 20 kg/sq.m.
- Refractory cancer kakheksiya. Is followed by the expressed deterioration in a condition of the patient, lack of reaction on himio-both radiotheraphy and inefficiency of medical actions for increase in body weight.
Symptoms of a cancer kakheksiya
Patients show complaints to sharp weakness, slackness, increased fatigue, fever, locks or ponosa. The daily rhythm of a dream wakefulness is broken: at night patients with a cancer kakheksiya suffer from sleeplessness, in the afternoon feel drowsiness. At women arises , at men lack of a libido is noted. Mental disorders develop. Many patients with a cancer kakheksiya suffer from a depression. The tearfulness, irritability and emotional lability which are replaced by apathy and indifference are observed. When progressing the main disease consciousness violations are possible.
At external survey of patients with a cancer kakheksiya exhaustion of various degree of expressiveness comes to light. Sometimes (as a rule – at tumors of ovaries, a uterus or the mammary gland which are followed by hormonal violations) patients have the normal or increased body weight. Skin of patients with a cancer kakheksiya dry, flabby, grayish or yellowish color with an earthy shade. Deepening of wrinkles, the expressed deficiency of hypodermic fatty cellulose, fragility of hair and nails, the raised hair loss is noted. Bezbelkovy hypostases, ascites or can be observed. Hypotonia and tachycardia are defined. Stomatitis develops, shaking and loss of teeth is possible. Anemia is determined by blood tests.
Diagnostics of a cancer kakheksiya
The diagnosis "a cancer kakheksiya" is established taking into account the anamnesis (existence of an oncological disease), complaints, the given external survey, laboratory and tool researches. In the course of diagnostics focus attention on reduction of amount of the consumed food, prevalence of catabolic processes over anabolic, the expressed disorders of function of skeletal muscles (reduction of muscle bulk, decrease in force of muscles), change of functional abilities of an organism and deterioration of life of the patient suffering from a cancer kakheksiya.
For assessment of level of anemia, a functional condition of a liver and kidneys carry out the general blood test, biochemical blood test and the general analysis of urine. At suspicion appoint the analysis of urine to septic complications on . In the absence of the diagnosis of the main oncological disease of patients with a cancer kakheksiya direct to a X-ray analysis of a thorax, ultrasonography of abdominal organs, a kolonoskopiya, gastroscopy, hysteroscopy, MRT of a brain and other researches (depending on alleged localization of a new growth). Appoint consultations of various experts: therapist, cardiologist, gastroenterologist, neurologist, endocrinologist, urologist, gynecologist etc.
Treatment of a cancer kakheksiya
Treatment is symptomatic. To patients with a cancer kakheksiya appoint the diet providing the use of digestible products with a large amount of proteins, fats, minerals and vitamins. Use medicines for increase in appetite and antivomitives. If necessary (at the expressed exhaustion, violation swallowing, heavy infectious complications) carry out parenteral introduction of glucose, amino-acid mixes, vitamins and electrolytic solutions. In parallel carry out therapy of the main disease.
The forecast in most cases adverse, especially at a refractory cancer kakheksiya. The condition of patients gradually worsens. Frustration of a homeostasis are aggravated because of violation of activity of various bodies and systems and the joining infectious complications. At loss of 30-50% of protein there comes the lethal outcome. Heavy general exhaustion, pneumonia and extensive decubituses become an immediate cause of death. From 20 to 50% of the patients having oncological diseases perish from a cancer kakheksiya.