Cancer cachexia. Cachexia - what is it: causes and treatment of the disease Stages of cachexia

Oncological disease can cause general exhaustion and weakening of the human body. Cachexia in cancer indicates advanced forms of a malignant tumor - a sharp decrease in body weight and severe weakness are signs of stage 3-4 oncology.

Types and causes of exhaustion

Rapid weight loss is never unreasonable - cachexia in oncological or endocrine diseases develops for a limited amount of time. There are 2 main groups of causes of exhaustion:

1. Exogenous (any external factors affecting weight loss - chronic and prolonged malnutrition, psychogenic anorexia, prolonged stress, severe common infectious diseases, constant medication with a negative effect on weight);
2. Endogenous (pathology of internal organs and endocrine glands - diseases of the pituitary and thyroid glands, diseases of any part of the gastrointestinal tract, cardiopulmonary failure, systemic diseases and oncology).

By eliminating external factors, it is possible to restore the human body without any special difficulties and consequences with the help of course therapy, but with the pathology of internal organs, the cure can take a long time, and the prognosis will not always be favorable. Especially if the examination revealed a malignant tumor of any localization.

Most often, the following types of severe weight loss and exhaustion occur:

• psychogenic;
• endocrine;
• cancer cachexia.

Rapid weight loss is a symptom that cannot be ignored: in case of unexplained weight loss, you should immediately consult a doctor in order to find out the cause of the pathological condition as early as possible. Often, the time factor plays a big role - in oncopathology, the detection of a disease in the first stages is a prognostically favorable variant of the disease.

Symptoms of the pathological process

The worst option is cachexia in cancer. In addition to rapidly progressive extreme exhaustion, the following manifestations of the disease may appear:

• constant and severe weakness;
• rapid onset of fatigue at minimal load;
• sleep problems (severe drowsiness or insomnia);
• lethargy, emotional apathy and mental disorders;
• skin and hair problems (flabbiness, dryness, pallor, hair loss);
• malnutrition (lack of appetite, dysphagia, nausea, vomiting);
• tendency to constipation;
• swelling in the limbs;
• frequent respiratory infections;
• hypotension (lowering blood pressure) with dizziness and fainting;
• anemia (drop in hemoglobin and red blood cells);
• problems in the mouth (stomatitis, periodontitis, tooth loss);
• women have irregular menstruation.

With rapid weight loss, there will always be additional complaints and symptoms indicating serious problems in the body. Regardless of what causes cachexia - a malignant tumor, endocrine pathology or psychogenic disorders - symptomatic therapy should be started immediately: a loss of more than 50% of the initial body weight can become an irreversible condition for a person.

Treatment of exhaustion

Having discovered a cachexic state, and without waiting for confirmation of the main diagnosis, it is necessary to start therapy as early as possible. The main principles of treatment are:

• correction of dehydration (droppers with nutrient solutions);
• normalization of nutrition (the introduction of a sufficient amount of protein, easily digestible fats, vitamins and microelements into the diet);
• the use of drugs that stimulate appetite;
• prescribing drugs for digestion (enzymes);
• according to indications, anabolic steroids and psychotropic drugs are used.

An important factor in therapy is the identification and elimination of the underlying cause of the pathological condition. In case of oncological disease, the operation is performed when the general condition improves and the body weight increases - surgical intervention against the background of severe cachexia is performed only for health reasons. Against the background of endocrine disorders, the introduction of drugs that correct hormonal balance into the treatment regimen leads to rapid weight recovery. With psychogenic factors, an important role in therapy is assigned to a psychotherapist.

Forecast for life

Confirmed cancer cachexia, in which life expectancy is limited to a short period of time, requires symptomatic therapy to improve the general condition of the sick person. Severe exhaustion against the background of oncology of any localization is the last stage of a cancerous tumor: most often, surgery and drug therapy help prolong life, but do not cure. The prognosis for life in a cachexic state on the background of a malignant tumor is unfavorable: in the vast majority of cases, death occurs within a few months from the moment of pronounced weight loss.

Any variant of weight loss in a short period of time is an extremely unfavorable sign, indicating the need for a full examination with mandatory treatment of malnutrition. Treatment and diagnostic measures should not be postponed - the sooner the doctor makes a diagnosis, the greater the chances of recovery.

Cachexia - what is it? Cachexia, in other words, exhaustion of the body, is a complex process characterized by a significant loss of body weight and general weakness, as well as a change in the psyche. At the same time, fat and carbohydrate reserves are sharply depleted, protein synthesis decreases with a simultaneous increase in its catabolism (destruction). Cachexia may also occur in oncological diseases.

Primary and secondary exhaustion

There are two forms of cachexia - primary and secondary. Primary exhaustion is also called pituitary, and secondary - symptomatic.

● Primary or exogenous cachexia occurs due to insufficient intake of nutrients, as well as as a result of the following disorders: brain injury, tumor or systemic damage to the pituitary gland, autoimmune hypophysitis, prolonged stress, hemorrhages (hemorrhages with thinning of blood vessels), anorexia, embolism ( entry into the blood stream of foreign particles that cause blockage of blood vessels), chronic specific infection.

● Secondary or endogenous cachexia is the result of diseases and is caused by factors such as hypoinsulinism (deficiency of insulin), increased synthesis of glucagon, malabsorption (malabsorption of nutrients), glucocorticoid deficiency, growth of neoplasms, excess somatostatin.

Causes

Cachexia disease occurs as a result of a number of causes and factors:
1. Prolonged malnutrition and starvation.
2. Diseases of the gastrointestinal tract, in particular the esophagus, as well as celiac disease, enterocolitis.
3. Prolonged intoxication with brucellosis, tuberculosis and other chronic infectious diseases and suppuration processes.
4. Psychogenic anorexia.
5. Diseases of the thyroid gland, adrenal insufficiency.
6. Endocrine diseases associated with
7. Heart failure.
8. Malignant tumors.
9. Hypotrophy in children.

What are the symptoms of cachexia? What are these manifestations?

Symptoms

There are a number of symptoms that characterize cachexia. does to our body:
1. Sudden weight loss up to 50% of body weight, and in severe cases more than 50%.
2. Dehydration.
3.
4. Loss of ability to work.
5. Sleep disorders.
6. Increased infection damage.
7. Decreased blood pressure (blood pressure).
8. Paleness and flabbiness of the skin.
9. Possible vitamin deficiency and tooth loss.
10. Trophic changes in hair and nails.
11. Development of stomatitis.
12. The occurrence of constipation due to impaired intestinal motility.
13. Low blood levels of protein, albumin, iron, B12.
14. Women may experience amenorrhea (cessation of menstruation).
15. Mental disorders.

Cachexia and the psyche

I would like to dwell on mental disorders in cachexia. They can manifest themselves in irritability, depression and tearfulness, which smoothly flow into apathy, a complete breakdown. With an exacerbation of the disease that caused cachexia, amentia / amental syndrome can be observed, characterized by an inability to navigate, chaotic movements and absent-mindedness, as well as incoherent thinking and speech) or delirium (insanity, in which a person is in a constant state of anxiety and arousal, sees hallucinations) , pseudoparalysis.

cachexia in oncology

Cancer cachexia is a syndrome in which the mass of skeletal muscle and adipose tissue continuously decreases with the development of tumor formations, regardless of food intake. Depletion is especially pronounced in those patients who have cancer of the gastrointestinal tract or lungs. Such people can lose as much as 80% of their body weight, leading to immobility.

Cancer as a Cause of Cachexia

Cachexia in oncological diseases is possible. The cause of cachexia may be the presence of a tumor. Due to the neoplasm, the metabolism becomes atypical, adjusting to it. The tumor needs substrates that can ensure its growth and development. It is no secret that cancer cachexia has a toxic effect on healthy organs and tissues, changing their structure and causing malfunctions.

When a large amount of lactic acid is formed in the tumor, the liver is damaged. In order to normalize the concentration of lactic acid, the body begins to use blood sugar and often cannot make up for the loss.

With cancer cachexia, there is:
- catastrophic weight loss and weakness;
- violation of self-regulation processes;
- lowering plasma cholesterol levels;
- the development of infections due to impaired cellular and humoral immunities;
- dysphagia (difficulty swallowing);
- vomiting, diarrhea;
- increase in energy demand;
- antidiuresis and, as a consequence, hyponatremia;
- hypercalcemia;
- swelling;
- increase in blood glucocorticoids;
- in some cases, delirium and even coma.

Consequences of cancer cachexia

Oncological cachexia is very dangerous. An increase in glucocorticoids in the blood activates the processes of gluconeogenesis (glucose synthesis) in the liver and muscle tissue, increases the breakdown of proteins and fats. Due to the absorption of glucose by cancer cells, hypoglycemia (low blood glucose) develops. Against this background (to which stresses can be added), the endocrine glands actively produce hormones, an excess of which leads to intoxication of the body and hemic hypoxia (the difference in the arterial-venous oxygen gradient decreases). Homeostatic deviations occur. All this can lead to death.

Treatment of cachexia

Most of the treatment of patients with cachexia is carried out in hospitals or dispensaries. The main treatment includes therapy to get rid of neoplasms. Nutrition is also being restored, which is achieved by enriching the body with vitamins, microelements, fats and proteins. For this, easily digestible products can be used. Use such drugs: multivitamin for the treatment of hypovitaminosis, enzyme to improve digestion. Food is administered in two ways: enteral (when it enters the gastrointestinal tract) and parenteral (food passes by the gastrointestinal tract). The parenteral method is used to remove the patient from a serious condition (coma) with cancers and treatment after them, severe malnutrition, severe infections, and swallowing disorders. At the same time, glucose, vitamins, amino acid mixtures, electrolytes, protein hydrolysates are administered (introduced parenterally). Appetite enhancers are also used in practice. If the patient suffers from impaired digestion of food and its absorption, polyenzymatic preparations are used in the treatment (drug "Pancreatin", drug "Festal").
To prevent vomiting, prescribe the drug "Delta-9-tetrahydrocannabinol". It is also effective after chemotherapy. The cannabinoids contained in this preparation stimulate appetite, and, accordingly, weight gain. can be stopped with fish oil, so it is also included in the treatment program for a disease such as cachexia.

Treatment with drugs.
To eliminate cachexia, the following drugs are used:
1) "Carboxylase" - helps to normalize weight, relieves pain and supports the functioning of body systems. Side effects - allergies. Do not use if the body is susceptible to at least one component.
2) "Megeys" or "Megestrol acetate" - stimulates an increase in muscle mass and fat. Do not use in the presence of sensitivity to the components of the drug, persons under 18 years of age, during pregnancy and breastfeeding.
In the presence of infectious diseases, antibiotic therapy is included in the treatment. If necessary, anabolic hormones are administered. In cases of psychogenic disorders, a psychiatrist is involved in the treatment.
We hope that we have answered your question "Cachexia - what is it, how to define it and how to fight it".

And diseases of the gastrointestinal tract that occur with syndromes of impaired digestion and absorption of food (chronic enterocolitis, -, condition after gastric resection, gastrectomy), psychogenic, long-term in chronic infectious diseases (tuberculosis, brucellosis, etc.) and purulent processes (abscesses, festering bronchiectasis, osteomyelitis), debilitating (especially nodular), severe, malignant (cancerous K.), metabolic and energy disorders (Metabolism and energy) in endocrine diseases, especially with panhypopituitarism (pituitary K. - see Hypothalamo-pituitary insufficiency ) , adrenal insufficiency, thyroid disease. To. at children is, as a rule, a consequence of a hypotrophy (see. Dystrophy at children ).

K.'s pathogenesis is determined by the disease that caused it, but in all cases it includes profound metabolic disorders with depletion of fat and carbohydrate reserves, increased protein catabolism and a decrease in its synthesis.

Clinically K. is shown by sharply expressed weakness, disability, sharp weight loss. which is often associated with signs of dehydration (Dehydration) , although in some cases hypooncotic (protein-free) edema of the subcutaneous tissue and accumulation of transudate in various body cavities are observed. In severe cases, weight loss can reach 50% or more. patients become pale, or sallow-gray, flabby, wrinkled: the subcutaneous tissue decreases sharply or disappears, often there are signs of vitamin deficiency (Vitamin deficiency) . Trophic changes in hair and nails are noted. Develops , often fall out ; the intestines are disturbed, stubborn ones are often noted. Sexuality decreases, in women it occurs. The volume of circulating blood decreases, usually reduced. Determined, hypoalbuminemia, often also iron- or B 12-deficient. Decreased glomerular filtration in the kidneys.

This disease changes the patient beyond recognition. Flashbacks from World War II documentaries about concentration camps come to mind. In modern life, the causes of cachexia are caused by a wide range of factors.

• Diseases of the esophagus (stenosis), in which it is difficult for food to enter the patient's stomach.
• Fasting for an extended period of time.
• Severe form of heart failure.
• Chronic forms of brucellosis and tuberculosis, in which the patient's body is subjected to prolonged intoxication.
• Nodular polyarthritis.
• Purulent processes in the body (progressive osteomyelitis and abscesses, festering bronchiectasis).
• Cancer tumors.
• Diseases of the gastrointestinal tract, the consequences of which are the failure of the functions of digestion of food and the absorption of its mucosa (gastrectomy, enterocolitis, the consequences of gastric resection (celiac disease), and so on).
• Amyloidosis.
• Failure of the endocrine system, violation of metabolic processes (pathology of the adrenal glands and the work of the thyroid gland).
• psychogenic anorexia.
• Prolonged use of psychostimulants.
• Malnutrition.
• Diseases of connective tissues of a diffuse nature.
• Hypotrophy in young patients.
• Acquired immune deficiency syndrome (AIDS).

Symptoms of cachexia

The course of the disease, the predicted outcome, and, accordingly, the symptoms of cachexia largely depend on the nature of the disease that caused it. But the main symptoms are:

• Rapid weight loss (severe cachexia indicates a loss of half of a person's normal weight).
• Loss of ability to work.
• Decreased general vitality.
• A dangerous loss of fluid by the body, its accumulation in the serous cavities of the body is a consequence of a failure of blood circulation and lymph flow (transudate).
• Loss of fat cells.
• General weakness.
• Avitaminosis.
• Protein-free edema.
• The skin is flabby, wrinkled, the color is unnaturally pale, gray-green.
• Increased fragility of hair and nails.
• Stomatitis.
• Dysbacteriosis.
• Constipation.
• Loss of teeth.
• Decreased immunity.
• Amenorrhea in women (absence of menstruation for several menstrual cycles).
• Deterioration of potency in men.
• Failure of intestinal peristalsis.
• Blood pressure is low.
• Constant feeling of cold.
• Decreased glomerular filtration in the kidneys.
• Reducing the volume of circulating blood.

Frequent mental disorders:

• Asthenia.
• subdepressive mood.
• Tearfulness.
• Clouding of consciousness.
• Apathetic stupor.
• The psycho-organic syndrome is less common.

Degrees of cachexia

Doctors distinguish three degrees of cachexia:

Hypothalamic form of the disease. It is characterized by complete or partial cessation of peptide synthesis in human plasma. The consequences of such a failure:

• Inhibition of the production of protein kinases (phosphotransferases) involved in the modification of many proteins.
• Blocking the process of lipogenesis, which includes the breakdown, digestion and absorption of lipids in the digestive tract, the transport of fats from the intestines, the metabolic transformations of triacylglycerols, cholesterols and phospholipids.
• Decreased activity of endothelial lipoprotein lipase (regulates the level of lipids in the blood, which is essential in atherosclerosis).
• There is a suppression of anabolism (metabolic processes).
• The transport of fats is slowed down.
• There is an intensification of catabolism (energy metabolism).

Cahechtinous form of the disease. It is accompanied by increased production of cachechtin, as a result of which the following are observed:

• Frequent and prolonged emotional breakdowns.
• Loss of appetite.
• Imbalance in the synthesis of neuropeptides (protein molecules formed in the central or peripheral nervous system and regulating the physiological functions of the human body).
• The rapid development of anorexia (pathological weight loss).

Anorexic form of the disease. It is represented by malabsorption (impaired absorption of substances in the small intestine):

• An increase in the number of new formations, such as necrotic alpha tumors in the blood plasma.
• Thymus hormone deficiency.
• Hypocorticism (pathological changes caused by hypofunction of the adrenal cortex).
• Hypoinsulinism (an endocrine disease characterized by attacks of a significant decrease in blood sugar).

Classification of cachexia

Depending on the etiology of the disease, cachexia is classified in several directions:

Exhaustion of the body associated with exogenous factors (influence of the environment, the external environment):

• Lack of nutrition.
• Starvation (of a religious nature or a manic desire to lose weight).

Endogenous causes (internal failures):

• Chronic stage of radiation sickness.
• Violation of the work of the adrenal glands.
• Senile involution of the organism.
• The presence of a malignant tumor.
• Violation of the endocrine glands.
• Myxedema (insufficient supply of organs and tissues of the body with thyroid hormones).
• Consequences of trauma.
• Terminal (dystrophic) form of chronic heart failure.
• Postoperative hypothyroidism (long-term, persistent lack of thyroid hormones).
• A significant decrease in mental activity.

Pituitary cachexia

Violation of the integrity of the functioning of the anterior pituitary gland and hypothalamic centers, manifested in insufficient production or complete absence of production of triple hormones of the adenohypophysis, leads to the appearance of hypocorticism (dysfunction of the adrenal glands), hypothyroidism (decrease in thyroid function) and hypogonadism (decrease in the amount of produced male sex hormones - androgens). All these failures lead to the fact that pituitary cachexia develops in the patient's body.

The cause of this pathology can be:

• Injury.
• Inflammatory process in the pituitary gland.
• Malignant or benign tumor.
• Bleeding and collapse during childbirth, followed by ischemia or vascular thrombosis in the hypothalamus-pituitary gland.
• Spasm and thrombosis of the arteries supplying blood to the anterior lobe and stalk of the pituitary gland cause necrosis of the adenohypophysis.

Cerebral cachexia

Cerebral cachexia is diagnosed with pathological changes in the hypothalamus. Often, the disease affects not only the pituitary gland, but also inflammatory, dystrophic processes affect the diencephalon. When such a pathology dominates the pituitary gland, and there is a sharp weight loss, doctors diagnose the cerebral form of the disease.

There are known cases of sudden weight loss, while studies have not revealed any abnormalities in the work of the endocrine system. Often, such patients have a history of psychological trauma (shock, fright). Anorexia of this nature is quite common and leads to the onset and progression of the cerebral form of the disease. It is very difficult to treat a disease of this etiology, since medicine has not fully studied all the processes occurring in the brain.

Alimentary cachexia

If the cause of anorexia is prolonged malnutrition, malnutrition, voluntary or forced starvation, general exhaustion of the body develops, doctors refer this pathology to alimentary cachexia.

With such a pathology, a failure occurs in all metabolic processes of the body, dystrophy of organs and tissues progresses, disrupting their functioning. A person's physical activity decreases, changes in the psychological perception of the surrounding society appear.

The alimentary form of the disease acquires a mass social status during natural disasters (loss of food during floods and earthquakes ...) and social conflicts (war, artificial famine).

During a period of prolonged malnutrition, the body does not receive the nutrients, vitamins and microelements necessary for normal functioning, which are a source of energy. This leads to a reduction in energy costs, loss of psychological, intellectual and physical capacity for work. There is a redistribution of the necessary substances, which contributes to a mismatch in the work and trophism of various systems and organs. The hormonal background undergoes restructuring (malfunction of the thyroid gland, glands of the reproductive system, adrenal glands). The restriction of protein food provokes hypoproteinemia, which is manifested by protein swelling.

Gradually, atrophy of the muscles of the skeletal frame occurs, the patient loses subcutaneous tissue. When conducting studies of such patients, a decrease in the size of the liver by 2–2.5 times is revealed, and other organs also atrophy.

Malignant cachexia

Malignant cachexia is more likely to occur in patients suffering from the rapid decomposition of the tumor conglomerate, while the size of the tumor does not matter.

Causes of exhaustion:

• Intoxication of the body with toxins of cancer cells or "waste products" of concomitant complications.
• The accumulation of an excess amount of lactic acid, which has a detrimental effect on the state and functioning of the liver. The patient's body counteracts it by breaking down sugar in the blood, mobilizing its carbon reserve. It cannot make up for the loss.

Most often, the malignant form of the disease is a companion of cancerous tumors of the gastrointestinal tract, respiratory tract. Due to diseases of the digestive system, there is an aversion to many foods. As a result, the body does not receive many nutrients necessary for normal life.

However, cases are not uncommon (for example, skirr - a type of stomach cancer - a sharply deforming organ that disrupts its motility and secretory work) when cachexia does not occur. While small tumors can provoke its rapid progression. Therefore, it is impossible to unambiguously identify the cause of the pathological deviation today.

Cardiac cachexia

As a result of a lack of nutrients, the myocardium is also exposed to pathological effects. The heart gradually loses its pumping ability to pump blood in the volume necessary for the normal functioning of the body. Defects and coronary heart disease lead to a similar result. As a result, a person acquires heart failure. In severe forms of chronic heart failure, significant weight loss is observed. This pathology is classified as cardiac cachexia.

Until the end, the mechanism of the appearance and development of cachexia is not clear, but it is definitely composed of multiple factors. The main ones for the cardiac form of the disease are:

• Hepatomegaly, which is caused by stagnation of blood in the venous system.
• Persistent feeling of fullness in the stomach.
• An increase in the number of inflammatory cytokines.
• Violation of intestinal motility.

It is very difficult to diagnose cachexia of this etiology, but the prognosis for recovery with it is quite favorable.

Senile cachexia

A person ages because his body ages. There is a slowdown in metabolic processes, the regeneration of the skin is slower, and so on, but the strong depletion of the body of an old person cannot be attributed to the norm. Often after the age of 50, there is a significant reduction in muscle mass, while the amount of fat increases. These are the consequences of a sedentary lifestyle, sedentary work, dietary restrictions.

The body ages, various diseases appear, which can cause severe depletion of the body, which falls under the category of senile cachexia.

Treatment of cachexia

Sharp exhaustion is already a consequence of external factors or some diseases that affect the body. Therefore, the treatment of cachexia is reduced to the elimination, first of all, of the causes that prompted progressive weight loss. If the wasting is a consequence of the disease, then the patient must undergo a full course of treatment. If cachexia was provoked by external factors, it is necessary, accordingly, to minimize their impact and undergo restorative therapy.

But a mandatory item in the normalization of the patient's condition is the systematic restoration of a balanced diet, careful care for him. Without fail, easily digestible proteins, vitamins, fats, foods rich in trace elements are introduced into the diet. If the patient has symptoms of a malfunction in the digestive tract and the suction system, the doctor prescribes polyenzymatic medications, such as pancreatin.

• Pancreatin

The volume of the prescribed drug depends on the age of the patient and the degree of lack of enzymes produced by the pancreas. The drug is taken before meals or with food, drinking plenty of water or, preferably, an alkaline liquid (fruit juice).

The average daily dosage of the drug, divided into three to six doses, is 0.25 - 0.5 grams. In case of complete insufficiency of the secretory function, the dosage is increased to 0.75 grams of daily. For babies under the age of one and a half years, the starting dose is 0.1 grams, for older children - 0.2 grams.

The duration of the treatment course depends on the severity of the disease and varies from several days to months and years.

The contraindications of the remedy include:

• Individual intolerance to one or more components that make up the drug.
• Acute or chronic pancreatitis at the stage of exacerbation.

When taking the drug, side effects may occur:

• Inflammation of the pancreas.
• Allergic reactions.
• With prolonged use - hyperuricosuria (urinalysis shows an increased amount of lactic acid).

If the patient is in serious condition, he is parenterally (bypassing the intestines - injections intramuscularly or intravenously) inject glucose, amino acid mixtures, vitamins, protein hydrolysates. If necessary, the doctor connects anabolic steroids (for example, andriol).

With cachexia of a psychogenic nature, a psychiatrist and a neurologist give their prescriptions (for example, drugs that increase appetite: periactin, primobolan depot).

• Glucose

The drug is administered both orally, intravenously, and by intramuscular injection. The dosage of one dose is 0.5 - 1 gram.

Subcutaneously or into a vein, glucose is supplied with a solution of 4.5 - 5% in an amount of 300 - 350 ml. In the form of enemas - up to two liters per day.

With a large volume of the administered drug in the patient's body, a water-salt imbalance, an increase in fluid, and thrombosis may occur.

The only contraindication to the use of glucose may be the patient's diabetes mellitus.

• Andriol

The required dose is assigned by the attending physician purely individually, depending on the clinical picture. The recommended initial daily amount is 120-160 mg for two to three weeks, followed by a decrease in dosage to 40-120 mg daily. The capsule of the drug is drunk after a meal, if necessary with a small amount of liquid. Do not chew or open the capsule, swallow it whole. The daily dosage is divided into two doses: morning and evening. If the daily amount is an odd number of capsules, a large dosage is taken in the morning.

The drug is contraindicated for use by patients with a history of verified carcinoma of the prostate or breast.

• Periactin (Periactin)

The drug is attributed by the doctor to raise the patient's appetite. The adult dosage is:

• tablets - 0.5 - 1 piece three - four times a day.
• syrup - one - two teaspoons three - four doses per day.

Children aged two to six years - the maximum daily dose is two tablets or two tablespoons of syrup.

Children from 6 to 14 years old - the maximum daily amount of medicine is three tablets or three tablespoons of syrup.

The drug is contraindicated in cases of increased intraocular pressure, asthma, stomach ulcers, and the elderly.

• Primobolan-Depot (Primobolan Depot)

The drug is administered intramuscularly:

• adults, one ampoule every two weeks, then 1 ampoule every three weeks.
• for children, the dosage is administered at the rate of 1 mg per kilogram of the baby's weight once every two weeks.

The medicine is contraindicated in men suffering from prostate cancer and pregnant women.

Nutrition for cachexia

The diagnosis of wasting is made to a person if his weight deviates significantly from the norm. Just as it is a problem for obese people to lose weight, so for very thin people it is a real problem to gain weight and bring it back to normal. In addition to medical means, nutrition in case of cachexia is also capable of normalizing the patient's weight.

Such patients often lack appetite, and it is quite problematic to feed them. Therefore, it is worth starting with small, but high-calorie portions. The body must gradually "get used" to food. The maximum effect is achieved if the meal is divided into five to six approaches and is subject to the schedule. Eating at the same time causes the patient's digestive system to be stimulated. Dishes should be tasty and aesthetically appealing - this is another incentive to stimulate appetite. Forcing a person to eat through force can achieve the opposite result.

Food should be varied, balanced, stimulating the desire to eat more. Nutritionists advise:

• First courses on rich broth or strong broth with dressing of sour cream, cream or egg yolks.
• Smoked fish.
• Peppered sauces.
• Spices.
• Fruit and vegetable freshly squeezed juices.
• Desserts.

If there are no medical contraindications, then you can eat everything. It should only be remembered that they must be high-calorie. It is also necessary to cook dishes using vegetable and butter oils, cream. The diet of such a patient must include:

• Muffin.
• Drinks containing a large amount of fat.
• High calorie desserts.

Pieces of meat and fish are best baked with vegetables or fried in vegetable oil. Fatty meats go well with sour and spicy sauces and seasonings (spicy sauce, horseradish, adjika, lemon, mustard).

Salads consumed by the patient should contain:

• Boiled vegetables with butter.
• Vegetables fried and stewed.
• The perfect condiment is mayonnaise.

For a side dish in this case, fit:

• Cereal porridge seasoned with butter.
• Pasta.
• Boiled potatoes with butter.
• French fries.
• Potatoes - mashed with milk, cream or sour cream.
• Potato baked with fat.

Dessert can be taken not only at lunchtime, but also with another meal:

• Cottage cheese casseroles, pasta and cereals.
• Pies and kulebyaki.
• puddings.
• Desserts can be not only sweet, but also salty.

Prognosis for cachexia

Any prognosis depends on the nature of the disease, the severity of its course. The prognosis for cachexia directly depends on the factors and the disease that provoked it. Cachexia, provoked by a cancerous tumor, speaks of a neglected late stage of the disease and gives an unfavorable prognosis for recovery. If a sharp depletion is caused by other reasons, then such a patient has a chance to recover, but on condition that adequate effective treatment is carried out, in compliance with the diet and lifestyle of the patient.

In nature, everything is harmonious and a deviation, both towards a large weight, and its sharp loss leads to serious illnesses, the final of which can be a fatal outcome.

Cachexia is not a sentence (except for oncological diseases) and it can be fought, but this must be done only under the vigilant supervision of a certified specialist. Self-activity in this case is inappropriate, because your life is at stake!

Cachexia is called extreme exhaustion of the body, characterized by a sharp decrease in weight, general weakness, a decrease in the activity of physiological processes, which leads to a change in the mental state of the patient.

Depending on the cause that caused this condition, weight loss can be significant and in some cases reaches 50% or more. This is accompanied by a sharp decrease, followed by the complete disappearance of subcutaneous tissue. Symptoms of hypovitaminosis are also observed, as a result of which the skin turns pale or acquires an earthy shade, and also becomes wrinkled and flabby.

Cachexia is also characterized by trophic changes in nails and hair, stomatitis, severe constipation, decreased sexual function, hypoalbuminemia and hypoproteinemia.

Mental disorders accompanying cachexia usually manifest as irritable weakness, tearfulness, subdepressive mood. Against the background of an exacerbation of the underlying disease that caused cachexia, it is possible to develop clouding of consciousness in the form of amentia, twilight clouding of consciousness, severe or rudimentary forms of delirium, followed by apathetic stupor, anxiety-dreary states and pseudo-paralytic syndrome. Prolonged asthenia, sometimes combined with manifestations of a psychoorganic syndrome, usually remains even after the underlying disease has been cured.

There are 3 types of cachexia based on protein loss:

• Marasmus, expressed in the depletion of peripheral and energy protein reserves. The disease is characterized by symptoms of atrophy of skeletal muscles and subcutaneous fat. At the same time, the function of the liver of other internal organs is preserved;
• Kwashiorkor, which is a severe form of alimentary dystrophy, developing due to protein starvation;
• mixed form.

Causes of cachexia

Causes of cachexia can be various diseases and conditions. Most often, the disease develops as a result of:

• Diseases of the gastrointestinal tract with symptoms of impaired absorption and digestion of food - chronic enterocolitis, celiac disease;
• Stenosis of the esophagus, accompanied by difficulty in getting food into the stomach;
• Psychogenic anorexia;
• Starvation or prolonged malnutrition;
• amyloidosis;
• Prolonged intoxication against the background of chronic infectious diseases - brucellosis, tuberculosis, various purulent processes;
• Debilitating diffuse connective tissue diseases;
• Malignant tumors (cancerous cachexia);
• Metabolic disorders against the background of endocrine diseases, especially with hypothalamic-pituitary insufficiency;
• severe heart failure;
• Hypotrophy in children;
• Acquired immune deficiency syndrome.

Also, the causes of cachexia can be prolonged use of psychostimulants and insufficiency of the adrenal glands and thyroid gland.

Cancer cachexia

Cancer cachexia is a frequent manifestation of the impact of malignant tumors on the body. As a rule, it does not depend on the localization of the tumor, although it most often accompanies tumors of the gastrointestinal tract.

The reasons for the development of cancerous depletion have not been fully identified, however, cachexia is associated with two phenomena:

• Atypism of metabolic processes in the tumor tissue and its increased need for substrates that are used for growth;
• The toxic effect of tumor processes on the metabolism, function and structure of non-tumor organs and tissues.

Deviations of homeostasis caused by pathology lead to the development of processes incompatible with life.

Pituitary cachexia

Pituitary cachexia (otherwise - Simmonds disease or diencephalic-pituitary cachexia) is a disease with specific signs of hormonal insufficiency of the adenohypophysis, accompanied by various neurovegetative manifestations that develop against the background of a sharp decrease in body weight, as well as violations of other body functions that are associated with the work of the pituitary gland.

This disease can occur due to:

• Damage or tumors of the pituitary gland;
• Postpartum hemorrhage in women.

The disease proceeds with a sharp decrease in the secretion of tropic pituitary hormones, observed in most patients with adenohypophysis insufficiency, which causes atrophy of the peripheral endocrine glands - the thyroid, genital, adrenal cortex. Simultaneously with a decrease in the plasma concentration of hormones secreted by these glands (cortisol, T3, T4, aldosterone, estradiol, progesterone, testosterone, and others), their reserve capabilities also decrease.

Diagnosis and treatment of cachexia

Diagnosis of cachexia due to severe weight loss is usually not difficult. The difficulty arises at the initial stage of exhaustion while maintaining adipose tissue and the developing process of lack of energy protein and metabolism. Three types of diagnostics are usually used:

• Clinical and anamnestic, based on the clinical picture, analysis of concomitant diseases, study of anamnesis;
• Laboratory, based on the assessment of biological analyzes of protein, blood, albumin, blood sugar levels and others;
• Anthropometric, including measurement of body weight BMI / RMI and assessment of critical weight loss over a certain period of time.

Treatment of cachexia depends on the underlying disease. It is carried out only in stationary conditions. Therapy involves restoring gastrointestinal function, usually with polyenzymatic drugs and, in some cases, with appetite stimulants, growth hormones, and gluconeogenesis inhibitors.

With cachexia, it is necessary to restore the nutrition of patients by enriching the diet with fats, proteins and vitamins, for which easily digestible foods are usually used. For removal from a serious condition, parenteral administration of a glucose solution, electrolytes, vitamins, protein hydrolysates, amino acid mixtures is possible.

The prognosis for treatment of cachexia also usually depends on the underlying disease, and it is determined individually. However, in almost all cases, a conversation with a psychotherapist is shown to correct mental disorders.