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Abnormalities in Metabolism
There is extreme weight loss caused by abnormalities in the glucose metabolism, in which cancer patients cannot produce glucose efficiently from carbohydrates and instead ‘feed off ’ their own tissue protein and convert it into glucose instead.

Glucose intolerance occurs due to increased insulin resistance and inadequate insulin release. There is increased breakdown of fat, free fatty acids and glycerol turnover and decreased generation of fat. Fat oxidation rates are high.

The rate of catabolism exceeds the synthetic rate, depletion of body protein occurs. Albumin is depleted. Branched chain amino acid infusion can decrease protein catabolism.

Anorexia (Distaste for food)
  • The anorexia is frequently accompanied by depression and discomfort.
  • This contributes further to a limited nutrient intake at the very time the disease process causes increased metabolic rate and nutrient demand.
  • This imbalance results in a negative nitrogen balance and indication of tissue wasting leading to “cancer cachexia”.
  • Loss of appetite can occur due to the systemic effect of malignant tumour.
  • It may be intensified by fear, depression, sepsis or can develop as a consequence of treatments like surgery, radiation, chemotherapy, and other drugs.
Anorexia leads to weight loss and malnutrition.
Malabsorption
This occurs due to blind loop syndrome.
  • The associated overgrowth of bacteria in the upper small bowel may result in steatorrhoea (fat malabsorption) and Vit B12 deficiency.
  • Protein loss enteropathy can occur in intestinal lymphoma and gastric carcinoma and also tumours arising outside the alimentary tract.
  • Pancreatic or tumours in the bilary duct cause deficiency of digestive enzymes, bile salts, etc.
  • Bilary obstruction can cause prothrombin deficiency, leading to clotting problems and deficiency of bile flow.
  • This interferes with calcium absorption causing osteomalacia. Protein and electrolytes absorption as well as other nutrients may also be diminished by solid tumour infiltration of the small intestine.
  • Abnormal tumours may also cause gastric or jejuno-colic fistulas resulting in bypass of small intestine leading to malabsorption. Diarrhoea, steatorrhoea, as well as protein flow. Extensive protein may also be lost in exudates associated with various gastrointestinal enteropaties
Fluid and Electrolyte imbalance

Gastrointestinal lesions leading to general malabsorption can also contribute to fluid and electrolyte losses. Ensuing vomiting and diarrhoea not only bringing water but also water soluble vitamins.

Anaemia

This is compounded by a number of factors including anorexia, curtailment of dietary nutrients necessary for haemoglobin synthesis like; iron, protein, folic acid, Vit B12 & C. Additional contributory factors may increase hemolysis, bleeding of ulcerated lesions or presence of gastrointestinal fistulas.

Taste & Appetite changes

These are due to psychosomatic factors, fear, pain, and side – effects medications. Diet prescribed should be according to patient preferences.

Chemotherapy of head, neck radiation may cause taste blindness and inability to distinguish basic tastes. Aversion is basically for protein foods.

Learned Food Aversions

Psychologic factors undoubtedly play a role in appetite. The stress of diagnostic procedures are exacerbated by the physiologic and metabolic effects of various anti-tumour intervention. Those stresses can cause learned food aversion. This behaviour is the unconscious association of consumption of a particular food with nausea leading to avoidance of food.  

Hypercalcemia (high levels of calcium)

It is the most common complications of cancer. Approx 20-40% of patients with breast, squamaous, bladder, and renal carcinoma develop hypercalcemia. Osteomalacia

Certain tumours reduce plasma calcitrol concentration in conjunction with hypophosphotemia, thereby inducing an oncogenic osteomalacia. Gastric malabsorption of calcium and phosphate can also occur.
 
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