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General history
of cancer
General Reactions

Anorexia

Anorexia is the lack or loss of appetite and interest in food.

During the cancer process, anorexia can be induced in three different ways:

During cancer, anorexia may be due to cancer itself, its treatment or the psychological consequences of cancer (depression).

Biological anomalies related to cancer are sometimes observed:

Most therapies do promote anorexia, at least during the first days:

Anorexia may also be the consequence of psychological disorders induced by cancer:

Cachexia

Cachexia or general state alteration including major weight loss is the consequence of both anorexia and evolution of the cancer process. Various factors have been incriminated:

The easiest way to measure cachexia is to weigh the patient although the weight loss may be masked by oedema or effusion (like ascites). A loss of 10% to 20% of normal weight can be observed in cancers of the stomach or the oesophagus. There is a clear correlation between the weight loss observed before treatment and poor cancer prognosis.

Severe under nourishment may be observed during complicated treatment (such as radiotherapy for head and neck cancers or poorly tolerated chemotherapy). These therapies may have to be temporarily stopped in order to take corrective measures (such as hyperalimentation by nutritive components or IV feeding).

Severe cachexia is frequently observed at the end of life. Major emaciation is due to the disappearance of all muscular and fat masses. The skin becomes very fragile like parchment, dentures become too big for the mouth, the patient becomes skeletal. In such a state of under nourishment, complications arise very quickly: a dry mouth further reduces feeding, the body support zones are the target of necrosis process (decubitus bedsore).

Biologically, such cachexia induces an increased metabolism of lipids and proteins, anaemia (without any clear aetiology), hypo-albuminemia (further inducing oedema), hyponatremia.

Fever

Fever is a very frequent symptom at the end of life in cancer patients.

An infection should always be investigated (cf. chapter on emergencies), but generally is not proven (no germ).

Some cancers specifically involve fever during their evolution (Hodgkin’s disease, acute leukaemia, kidney cancer, osteogenic sarcoma, atrial myxoma), with sweating episodes, probably related to cytokine production.

More frequently, fever is observed with major tumour mass (almost the same mechanisms as for cachexia), with tumour necrosis (and the risk of anaerobic super infection).

Major liver metastases are often complicated by a moderate fever which can be notably reduced by anti-inflammatory drugs like cortisone.

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