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  • Review Article
  • Published:

Cachexia in patients with oesophageal cancer

Nature Reviews Clinical Oncology volume 13, pages 185–198 (2016)Cite this article

Subjects

Key Points

  • Weight loss, owing to malnutrition is common in patients with oesophageal cancer and is often associated with worse clinical outcomes

  • Cachexia in patients with oesophageal cancer is compounded by the location of the tumour and the fact that oesophageal cancer is often diagnosed at an advanced stage

  • Cancer-treatment-related loss of body and muscle mass are substantial and should be considered as part of the cachexia syndrome observed in patients with oesophageal cancer

  • Treatment with a curative intent involves exceptionally invasive surgery that often leads to profound postoperative weight loss and malnutrition, with adverse effects on both health-related quality of life and survival

  • An unmet need exists for early identification of cachexia in patients with oesophageal cancer, with appropriate assessment tools for each of its major domains, throughout all of its clinical phases

  • Management of patients with cachexia demands a complex multimodal approach, with early screening, nutrition support and mitigation of skeletal muscle loss

Abstract

Oesophageal cancer is a debilitating disease with a poor prognosis, and weight loss owing to malnutrition prevails in the majority of patients. Cachexia, a multifactorial syndrome characterized by the loss of fat and skeletal muscle mass and systemic inflammation arising from complex host–tumour interactions is a major contributor to malnutrition, which is a determinant of tolerance to treatment and survival. In patients with oesophageal cancer, cachexia is further compounded by eating difficulties owing to the stage and location of the tumour, and the effects of neoadjuvant therapy. Treatment with curative intent involves exceptionally extensive and invasive surgery, and the subsequent anatomical changes often lead to eating difficulties and severe postoperative malnutrition. Thus, screening for cachexia by means of percentage weight loss and BMI during the cancer trajectory and survivorship periods is imperative. Additionally, markers of inflammation (such as C-reactive protein), dysphagia and appetite loss should be assessed at diagnosis. Routine assessments of body composition are also necessary in patients with oesophageal cancer to enable assessment of skeletal muscle loss, which might be masked by sarcopenic obesity in these patients. A need exists for clinical trials examining the effectiveness of therapeutic and physical-activity-based interventions in mitigating muscle loss and counteracting cachexia in these patients.

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Figure 1: Stages of cancer cachexia.
Figure 2: The major domains of cachexia in patients with oesophageal cancer.
Figure 3: Possible mechanisms of muscle wasting in patients with oesophageal cancer.
Figure 4: Measurement of muscle-mass using CT.

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Authors and Affiliations

  1. Molecular Medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, Level 2, 17176, Stockholm, Sweden

    Poorna Anandavadivelan & Pernilla Lagergren

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  1. Poorna Anandavadivelan
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P.A. researched data for this article, both authors made a substantial contribution to discussion of content, both authors wrote the manuscript and P.L. reviewed and/or edited the manuscript before submission.

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Correspondence to Pernilla Lagergren.

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Anandavadivelan, P., Lagergren, P. Cachexia in patients with oesophageal cancer. Nat Rev Clin Oncol 13, 185–198 (2016). https://doi.org/10.1038/nrclinonc.2015.200

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