Hormonal and Nutritional Factors Contributing to Tumour Cachexia

  • K. C. H. Fearon
Conference paper


The majority of cancer patients lose weight (Nixon et al. 1980) and a proportion become emaciated to the point that they appear to die of starvation. This syndrome is known as cancer cachexia, the term cachexia being derived from the Greek words kaxos and hexis, meaning poor condition. The patient with cachexia is clinically characterised by the presence of anorexia, early satiety, severe weight loss, asthenia, anaemia and oedema (Caiman 1982). The importance of cachexia has been long recognised. As far back as 1932 Warren, in a post mortem study of 500 cancer patients, concluded that 22% of deaths were directly attributable to cachexia and this was the single most common cause of death in cancer patients. More recent studies (Inagaki et al. 1974) have suggested that this figure is closer to 10%, however, more than 50% of cancer deaths are attributable to sepsis, and there remains the complex relationship between nutritional depletion and a propensity to infection.


Cancer Cachexia Rest Energy Expenditure Negative Energy Balance Lipoprotein Lipase Activity Hospitalise Cancer Patient 
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  1. Aderka D, Fisher S, Levo Y et al (1985) Cachectin/tumour necrosis factor production by cancer patients. Lancet ii:1190CrossRefGoogle Scholar
  2. Balkwill F, Burke F, Talbot D et al (1987) Evidence for tumour necrosis factor/cachectin production in cancer. Lancet ii:1229–1232CrossRefGoogle Scholar
  3. Begg RW, Dickinson TE (1951) Systemic effects of tumour in force fed rats. Cancer Research ii:409–412Google Scholar
  4. Bessey PQ, Walters JM, Aoki JM, Wilmore DW (1984) Combined hormonal infusion stimulates the metabolic response to injury. Ann Surg 200:264–281PubMedCrossRefGoogle Scholar
  5. Beutler B, Cerami A (1987) Cachectin: more than a tumour necrosis factor. N Engl J Med 316:379–385PubMedCrossRefGoogle Scholar
  6. Bibby MC, Darble JA, Sahiri AA, Fearon KCH, Brennan RA, Tisdale MJ (1987) Characterisation of a transplantable adenocarcinoma of the mouse colon producing cachexia in recipient animals. JNCI 78:539–45PubMedGoogle Scholar
  7. Brennan MF (1977) Uncomplicated starvation versus cancer cachexia. Cancer Res 37:2359–2364PubMedGoogle Scholar
  8. Caiman KC (1982) Cancer cachexia. Br J Hosp Med 26:28–34Google Scholar
  9. Carswell EA, Old LJ, Kassel RL, Green S, Flore N, Williamson B (1975) An endotoxin-induced serum factor that causes necrosis of tumours. Proc Natl Acad Sci USA 72:3666–3670PubMedCrossRefGoogle Scholar
  10. Costa G, Bewley P, Aragon M, Siebold J (1981) Anorexia and weight loss in cancer patients. Cancer Treat Rep 65 [Suppl 5]:3–7PubMedGoogle Scholar
  11. DeWys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69:491–497PubMedCrossRefGoogle Scholar
  12. Eden E, Ekman L, Bennegard K, Lindmark L, Lundholm K (1984) Whole body tyrosine flux in relation to energy expenditure in weight-losing cancer patients. Metabolism 33:1020–1027PubMedCrossRefGoogle Scholar
  13. Emery PW, Lovell L, Rennie MJ (1984) Protein synthesis measured in vivo in muscle and liver of cachetic tumour-bearing mice. Cancer Res 44:2779–2784PubMedGoogle Scholar
  14. Fearon KCH, Selby P, Shapiro D et al (1988a) Tumour necrosis factor production and its effects on triglyceride clearance in patients with cancer. Clin Nutr 7 [Suppl]:48Google Scholar
  15. Fearon KCH, Hansell DT, Preston T et al (1988b) Influence of whole body protein turnover rate on resting energy expenditure in patients with cancer. Cancer Res 48:2590–2595PubMedGoogle Scholar
  16. Garlick PJ, McNurlan MA, Preedy UR (1980) A rapid and convenient technique for measuring the rate of protein synthesis in tissues by injection of [3H] phenylalanine. Biochem J 192:719–723PubMedGoogle Scholar
  17. Glass RE, Fern EB, Garlick PJ (1983) Whole body protein turnover before and after resection of colorectal tumours. Clin Sci 64:101–108PubMedGoogle Scholar
  18. Hansell DT, Davies JWL, Burns HJG (1986) The relationship between resting energy expenditure and weight loss in benign and malignant disease. Ann Surg 203:240–245PubMedCrossRefGoogle Scholar
  19. Heber D, Chlebowski RT, Ishibashi PE, Herrold JN, Black JB (1982) Abnormalities in glucose and protein metabolism in non-cachectic lung cancer patients. Cancer Res 42:4815–4819PubMedGoogle Scholar
  20. Heymsfield SB, McManus CB (1985) Tissue components of weight loss in cancer patients: a new method of study and preliminary observations. Cancer 55:238–249PubMedCrossRefGoogle Scholar
  21. Inagaki J, Rodriguez V, Bodey GP (1974) Causes of death in cancer patients. Cancer 33:568–573PubMedCrossRefGoogle Scholar
  22. Knox LS, Crasby LO, Feurer ID, Buzby GP, Miller CL, Mullen JL (1983) Energy expenditure in malnourished cancer patients. Ann Surg 197:152–162PubMedCrossRefGoogle Scholar
  23. Lindmark L, Bennegard K, Eden E, Ekman L, Schersten T, Svaninger G, Lundholm K (1984) Resting energy expenditure in malnourished patients with and without cancer. Gastrointestiology 87:402–408Google Scholar
  24. Lundholm K, Edstrom S, Ekman L, Karlberg I, Bylund AC, Schersten T (1978) A comparative study of the influence of malignant tumour on host metabolism in mice and man. Cancer 42:453–461PubMedCrossRefGoogle Scholar
  25. Morrison SD (1976) Control of food intake in cancer cachexia: a challenge and a tool. Physiol Behav 17:705–714PubMedCrossRefGoogle Scholar
  26. Nixon DW, Heymsfield SB, Cohen AE, Lutner MH, Ansley J, Lawson DH, Rudman D (1980) Protein calorie under-nutrition in hospitalised cancer patients. Am J Med 68:683–690PubMedCrossRefGoogle Scholar
  27. Pain VM, Randall DP, Garlick PJ (1984) Protein synthesis in liver and skeletal muscle of mice bearing an ascites tumour. Cancer Res 44:1054–1057PubMedGoogle Scholar
  28. Plumb JA, Fearon KCH, Carter K, Burns HJG, Caiman KC (1987) Energy expenditure and protein synthesis rates in an animal model of cancer cachexia. Br J Cancer 56:194Google Scholar
  29. Preston T, Fearon KCH, Robertson I, East BW, Caiman KC (1987) Tissue loss during severe wasting in lung cancer patients. In: Ellis KJ, Yasumura S, Morgan WD (eds) In vivo body composition studies. Institute of Physical Sciences in Medicine, London, pp 60–69Google Scholar
  30. Selby P, Hobbs S, Viner C et al (1987) Tumour necrosis factor in man: clinical and biological observations. Br J Cancer 56:803–808PubMedCrossRefGoogle Scholar
  31. Stovroff MC, Fraker DL, Norton JA (1989) Cachetin activity in the serum of cachetic tumour bearing rats. Arch Surg 124:94–99PubMedGoogle Scholar
  32. Theologides A (1977) Cancer cachexia. In: Winick M (ed) Current concepts in nutrition, vol 6. Wiley, New York, pp 75–94Google Scholar
  33. Vlassara H, Spiegel RJ, Doval DS et al (1986) Reduced plasma lipoprotein lipase activity in patients with malignancy-associated weight loss. Horm Metab Res 18:869–703CrossRefGoogle Scholar
  34. Warren S (1932) The immediate causes of death in cancer. Am J Med Sci 184:610–616CrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1990

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  • K. C. H. Fearon

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