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Pathogenesis, clinical features, and assessment of cancer cachexia

Aminah Jatoi, MD
Charles L Loprinzi, MD
Section Editor
Paul J Hesketh, MD
Deputy Editor
Diane MF Savarese, MD


Hippocrates described a syndrome of wasting and progressive inanition among patients who were ill and dying. The Greek words kakos, meaning "bad things," and hexus, meaning "state of being," have led to the term cachexia to describe this syndrome. Cachexia, a hypercatabolic state defined as accelerated loss of skeletal muscle in the context of a chronic inflammatory response, can occur in the setting of advanced cancer as well as in chronic infection, acquired immunodeficiency syndrome (AIDS), heart failure, rheumatoid arthritis, and chronic obstructive pulmonary disease [1]. Although body composition changes are not identical in all of these disease states, the term cachexia is used in all of these settings. (See "Palliative care: Assessment and management of anorexia and cachexia", section on 'Prevalence and clinical significance' and "Palliative care: Assessment and management of anorexia and cachexia", section on 'Etiology and pathogenesis'.)

Loss of appetite with weight loss is common among cancer patients [2-4]. However, the profound weight loss suffered by patients with cachexia cannot be entirely attributed to poor caloric intake. Insufficient oral intake is superimposed upon complex metabolic aberrations that lead to an increase in basal energy expenditure and culminate in a loss of lean body mass from skeletal muscle wasting. In contrast to simple starvation, which is characterized by a caloric deficiency that can be reversed with appropriate feeding, the weight loss of cachexia cannot be adequately treated with aggressive feeding.

This topic will review the definitions, pathogenesis, and clinical characteristics of cancer cachexia. Potential pharmacologic therapies for cancer-related anorexia/cachexia syndrome and a separate discussion of assessment and management of anorexia/cachexia in palliative care patients are discussed separately. (See "Pharmacologic management of cancer anorexia/cachexia" and "Palliative care: Assessment and management of anorexia and cachexia".)


Historically, cancer cachexia has been most often defined by loss of weight (eg, involuntary weight loss >10 percent) [5]. However, the measurement of body weight may underestimate the frequency of cachexia in patients who are overweight/obese, or who have gained weight because of edema or a growing tumor mass [6,7]. As an example, largely because of the obesity epidemic in industrialized nations, cancer patients who historically were visibly cachectic with a body mass index (BMI) <20 may not be discernible as cachectic and in fact, have a normal or increased BMI [8,9].

More recently, clinicians and researchers interested in cachexia have gathered formally to consider the definition of cachexia and its underlying or component elements as well as diagnostic criteria. The evolution of the concept of cachexia is expanding to encompass specific elements of body composition, functional consequences, and biochemical signs of specific metabolic change:

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Literature review current through: Nov 2017. | This topic last updated: Oct 02, 2017.
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