Define Clinical Manifestations and Nutritional Problems Associated with Cancer?
In the previous section we learnt that cancer results in several changes in the metabolism of carbohydrates, protein, fat, fluids and several micronutrients. Changes in metabolism along with altered structural/functional capacity get elicited in the form of cancer cachexia, increased morbidity and mortality. Major clinical signs and symptoms which are associated with the nutritional status of cancer patient include:
1. Anorexia with progressive weight loss and under nutrition.
2. Taste changes causing depressed or altered food intake.
3. Alterations in protein, carbohydrate and fat metabolism.
4. Increased energy expenditure despite weight loss.
5. Impaired food intake and malnutrition secondary to mechanical bowel obstruction at any level, intestinal dysmotility induced by various cancerous tumors,
6. Malabsorption associated with deficiency or inactivation of pancreatic enzymes, bile salts, failure of food to mix with digestive enzymes; fistulous bypass of small bowel, infiltration of small bowel wall or lymphatics and mesentery by malignant cells. Blind loop syndrome (blockage of small intestine resulting in stasis of the movement of food or digestive secretions) occurring with depressed gastric secretion or partial upper small bowel obstruction leading to bacterial overgrowth; malnutrition induced villous hypoplasia.
7. Protein losing enteropathy.
8. Metabolic abnormalities induced by tumor.
9. Anaemia of chronic blood loss and bone marrow suppression.
10. Electrolyte and fluid problems with persistent vomiting associated with intestinal obstruction or intracranial tumors, intestinal fluid losses through fistulas or diarrhoea.