Introduction
Cachexia is a "wasting" disorder that causes extreme weight loss and muscle changes, including body fat loss. This syndrome is more commonly known to affect people in the late stages of serious diseases like HIV (human immunodeficiency virus), cancer, COPD (chronic obstructive pulmonary disorder), diseases of the kidney, and congestive heart failure (CHF). The term "cachexia" has been derived from the Greek words "Kakos" and "Hexis," meaning bad condition.
Cachexia is an involuntary type of weight loss, whereas the other types are voluntary. People experiencing it lose weight without any changes in diet or exercise. One mechanism behind this is that people lose weight because they cannot consume the proper quantity and quality of diet for other reasons.
Also, these people experience changes in their metabolism. Thus, the body tends to break down too much muscle and fat. Factors that can affect the appetite are inflammation and substances produced by tumors. This can make the body burn calories faster than usual. Studies have shown that cachexia is part of the body's response to fight against the disease. The body breaks down fat and muscle when nutritional stores become low.
A person with cachexia undergoes various changes along with losing weight. The person tends to get weaker. Thus, the body becomes more vulnerable to infections. Thus, the affected person becomes more prone to die because of developed conditions. Nutrition and calories alone cannot help people recover from this condition.
What Are the Types of Cachexia?
Following are the three main categories of cachexia:
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Pre-Cachexia: It is clinically characterized as losing up to five percent of the body's weight while suffering from a known illness or disease. It is associated with loss of appetite, inflammation, and metabolic changes.
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Cachexia: This is the stage in which there is a loss of more than five percent of the body weight over 12 months or less when the individual has been diagnosed with a disease and is not trying to lose weight. Various other criteria for diagnosis include loss of muscle strength, tiredness, decreased appetite, and inflammation.
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Refractory Cachexia: This is the condition that is observed in cancer patients. This involves loss of weight, muscle, and functional loss, including failure to respond to cancer treatment.
What Exactly Happens in Cachexia?
The exact cause of cachexia is not known because this condition is a very complex process that involves various organ systems in the body. Cachexia causes insulin resistance in the body because insulin helps to take glucose from the blood, and the person’s body cannot get energy through glucose from the blood. The condition causes body fat, muscle, and liver to respond poorly to insulin.
How Is Cachexia Related To Cancer?
Studies have reported that up to 80 percent of the patients diagnosed with late-stage cancer have cachexia. Almost one-third of people with cancer face death due to this condition. The mechanism is that tumor cells release various substances that can reduce the appetite.
Also, patients with cancer undergoing treatment can experience severe nausea or damage to the digestive tract, thus making it difficult to eat and absorb nutrients. When the body gets fewer nutrients, it attempts to burn fat and muscle. Cancer cells use the limited nutrients left in the body for their multiplication and survival.
How Is Cachexia Caused?
As mentioned earlier, cachexia occurs in the late stages of serious conditions as follows:
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Cancer.
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Cystic fibrosis (condition of affection protein in the body.
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CHF or congestive heart failure (a condition in which the heart does not pump blood normally).
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COPD or chronic obstructive pulmonary disease (a condition of the lungs causing breathing difficulty due to airflow blockage).
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Chronic kidney disease.
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Rheumatoid arthritis (a chronic inflammatory disorder of the joints).
Who Can Get Cachexia?
The prevalence of cachexia is as follows:
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It can develop in five to 15 percent of people diagnosed with congestive heart failure or COPD.
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Up to 60 percent of people are diagnosed with lung cancer.
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Up to 80 percent of people are diagnosed with stomach and other upper gastrointestinal cancers.
Cachexia usually does not occur in early cancer stages. It is expected to occur in 80 percent of the cases with advanced cancer. Also, the condition is not just associated with cancer but can also develop with other conditions, such as HIV, heart disease, and kidney disease.
What Are the Symptoms of Cachexia?
The most common symptoms in these patients include:
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Weight loss and muscle mass.
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Loss of red blood cells or anemia.
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Loss of appetite.
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Fatigue.
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Weakness.
How to Diagnose Cachexia?
Besides asking questions about the family, medical, and personal history, the physician will use certain criteria to diagnose cachexia. First, the individual must have lost at least five percent of the body weight within the last 12 months or less. Also, a person should have a known illness or disease. The patient should also have at least three of the below-mentioned findings:
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Fatigue.
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Anemia: A clinical condition characterized by decreased red blood cells.
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Reduced muscle strength.
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Anorexia: Appetite loss.
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Low fat-free mass index: This is a calculation based on an individual's weight, body fat, and height.
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Decreased levels of the protein albumin.
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Increased levels of inflammation, which various blood tests can identify.
How Can Cachexia Be Treated?
No specific treatment or reversal method has been reported yet. However, the main goal of management is to alleviate the symptoms and improve the individual's quality of life. The following are the current therapies used for the management of cachexia:
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Adapted exercise after discussing with the physician.
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Appetite stimulants can be used, like Megestrol acetate.
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Medications that can help in decreasing inflammation.
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Drugs like Dronabinol can be used to improve nausea, appetite, and mood.
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Changes in the diet.
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Nutritional supplements.
Are There Any Complications?
Cachexia can prove to be a very serious condition. It can affect the primary disease treatment response of the individual. People diagnosed with cancer and cachexia are known to tolerate chemotherapy and other therapies that they need to survive to a lesser extent when compared to other individuals. Hence, individuals with cachexia have a lower quality of life and a poor prognosis.
Conclusion
The general outlook of cachexia is that there is no treatment available currently. However, studies are being done to understand this condition's exact cause and mechanism. Until now, discoveries have helped invent medicines to manage cachexia symptoms. Left untreated, it can decrease the quality of life and cause death. Thus, consulting a specialist at the earliest is crucial.
