Nutrition and cancer

NUTRITION AND CANCER

The incapacity to maintain the nutrition state is a particularly common problem between the mascots with cancer. The process of the disease and its treatment can take to severe caloric protein undernourishment, which is the paraneoplasico syndrome or secondary diagnosis commonest in the patient with cancer. She is one causes main of morbidity and mortality. The caloric protein undernourishment exists when the ingestion of macronutrients is inadequate to satisfy the metabolic requirements. It can be progressive wearing down, weakness, decay, commitment of the immune function, possible intolerancia to the therapy and finally the death.

The anorexy, the loss of the appetite or desire to eat, is the symptom commonest, can happen at the beginning of the process of as the tumor grows and the later metastatiza disease or. The anorexy this present in a 15%-25% of all the patients with cancer at the moment of the diagnosis and is almost universal between the patients with ample metastática disease. The anorexy is the cause commonest of the diminution of ingestion of nutrients, bringing with himself the undernourishment, the progressive starvation (progressive deterioration with muscular wearing down and change of the composition of the body) in the malignidad.

Caquexia is a clinical syndrome of wearing down showed by weakness and noticeable and progressive loss of corporal, greasy weight and muscle. The anorexy and caquexia frequently appear.

EFFECT OF THE THERAPIES OF THE CANCER: The collateral therapies of the cancer and their effects can also contribute to the progressive deterioration of the nutrition. The therapy can exert a direct influence, like the protein malabsorción and of fat after a surgery (gastroectomía), or indirect effects, such as the increase of the metabolic demands caused by the infection or a neutropénica febrile reaction (there is an increase in the necessity of calories of approximately 10%-13% by degree arrives of 39°C). The nutritious problems can be induced by each general type of antineoplásica therapy.

EFFECTS OF THE TUMOR: Many problems of nutrition come from a local effect of the tumor. The tumors in growth in tracto gastrointestinal, for example, can cause obstruction, nausea and vomit, deterioration of the digestion, delayed transit and malabsorción. The ovarian and genitourinarios cancers can be associated with ascitis leading to early satiety, progressive proteinic undernourishment (specially with loss of liquids during the surgery or paracentesis) and to electrolytic imbalances and of liquids. The pain related to the size or location of the tumor can be associated with serious anorexy and diminution of the oral ingestion. The tumors of the central system nervous that cause to confusion or somnolencia can affect the nutrition state because the lack of attention can lead to a diminution in the ingestion. In addition to the local tumorlike effects (or it is of the tumor in if or the answer of the patient to the tumor), the nutrition problems can also come from metabolic alterations. An alteration marked in the normal metabolism of carbohydrates, proteins can appear and lipids. The tumorlike cells can derive considerable energy from the glucose metabolism to lactate (cycle of Cori) more than of the complete oxidation but of dioxide of carbon and water (cycle of Krebs) In addition, the lactate conversion to glucose for the gluconeogénesis by the liver consumes 6 molecules of ATP by cycle of lactate-glucose, producing an inefficient cycle of energy. The tumorlike cells require of a greater amount of glucose like power plant, or altered enzymatic activity or relative hypoxia induced by precarious vascularización of the tumor. The mediators of caquexia primary (that is to say, caquexia without a mechanical or functional etiología), can include substances with characteristics similar to those of hormones or weave products of the guest that influence indirectly in the metabolism. These last ones include I number of citoquinas like the factor of tumorlike necrosis (TNF-alpha), interleuquina-6, and the interferon range. In addition, the movilizantes lipid factors also have been implied. The loss of enteric stimulation can increase the levels of circulating citoquinas.

EVALUATION NUTRICIONAL