Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0006625 (cachexia)
 5,650 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 58-year-old woman presented to a tertiary care centre with signs and symptoms of acute cholecystitis, cholelithiasis and diagnoses of a high-grade neuroendocrine tumour of the gallbladder primarily with peritoneal and liver metastases. She had a liver abscess secondary to Salmonella and Enterococcus fecalis that was drained and treated with appropriate antibiotics. Interestingly, the serum chromogranin A levels were within normal limits, but carcinoembryonic antigen was elevated, which helped evaluate responses and pick progression. She was treated with 10 cycles of palliative chemotherapy when malignancy associated complications started to recur, that is, cholangitis, worsening pain, cachexia, intestinal obstruction, etc leading to chemotherapy delays. Her disease progressed during these times with rapid deterioration of performance status. She died of septic complications postlaparotomy for intestinal obstruction. Her progression-free survival remained for 8 months with subjective and objective improvements, and her overall survival remained at 13 months. We describe the course of her illness and give a brief review of the literature.
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PMID:Malignant neuroendocrine tumour of the gallbladder with elevated carcinoembryonic antigen: case report and literature review. 2366 52

Relieving the suffering associated with cancer and its treatment in the physical, emotional, practical, and spiritual domains is impossible without impeccable symptom control. This review summarizes key features essential to the management of: anorexia/cachexia, bowel obstruction, diarrhea, fatigue, mucositis, and nausea/vomiting. Taken together, these are some of the most vexing symptoms for cancer patients. Well-managed symptoms enable the course of overall cancer care to be unimpeded.
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PMID:Treatment of non-pain-related symptoms. 2405 12

Patients with advanced pancreatic cancer (APC) require early and frequent palliative interventions to achieve optimal quality of life for the duration of illness. Evidence-based supportive treatments exist to maximize quality of life for any patient, whether receiving chemotherapy or not. This article provides a comprehensive review of symptoms with current treatment recommendations and directions for future development. Celiac plexus neurolysis improves pain in the majority of patients with APC and should be moved earlier in the analgesic paradigm. Malignant bowel obstruction can be palliated quickly with optimal management via gastric decompression, octreotide, parenteral opioids, and standing antiemetics. Recommendations are provided for best treatment of malignant gastroparesis, gastric outlet obstruction, and chemotherapy-induced nausea and vomiting in this population. Malignant ascites can be treated initially with diuretics and sodium-restriction in patients with an exudative process; however, an indwelling catheter is recommended for patients with recurrent ascites, particularly because of carcinomatosis or a refractory process. With exocrine insufficiency contributing to weight loss, pancreatic enzyme replacement is essential to improve nourishment in the majority of patients. Presently, megestrol acetate is the only U.S. Food and Drug Administration (FDA)-approved therapy for the anorexia-cachexia syndrome, although future developments are promising. Finally, patients with advanced pancreatic cancer should be screened and treated early for depression as a common comorbid diagnosis. Early palliative care consultation also helps address the existential and psychosocial concerns of patients facing death from pancreatic cancer in a holistic manner.
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PMID:A myriad of symptoms: new approaches to optimizing palliative care of patients with advanced pancreatic cancer. 2445 42

Duodenal adenocarcinoma (DACa) is a rare malignancy, the presenting symptoms of which are vague and nonspecific. We report the case of a patient presenting with symptoms of subacute small bowel obstruction whose CT scan revealed i) left adnexal mass and ii) compression of 3(rd) portion of duodenum with reduced aortomesentric angle consistent with Wilkie's syndrome (WS). Laparatomy in addition revealed a distal duodenal stricture, which showed a well differentiated DACa causing subtotal intestinal obstruction. The ovarian mass revealed adenocarcinoma with similar morphology. Immunophenotypic analysis revealed positive expression of CK 20 and CDX 2 and absence of CK 7 staining in the tumours consistent with Primary DACa with ovarian metastasis. We further concluded that the WS resulted from reduced mesenteric fat pad caused by DACa induced cachexia. The case highlights the elusive nature of duodenal malignancy and emphasises the importance of meticulous small bowel examination during exploration of ovarian masses.
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PMID:Wilkie's Syndrome and Left Adnexal Mass: Unusual Presentation of Duodenal Adenocarcinoma. 2530 1

Until recently, a diagnosis of peritoneal carcinomatosis was uniformly accompanied by a grim prognosis that was typically measured in weeks to months. Consequently, the management of carcinomatosis revolves largely around palliation of symptoms such as bowel obstruction, nausea, pain, fatigue, and cachexia. A prior lack of effective treatment options created the nihilistic view that currently exists and persists despite improvements in the efficacy of systemic therapy and the evolution of multimodality approaches including surgery and intraperitoneal chemotherapy. This article reviews the evolution and current state of treatment options for patients with peritoneal carcinomatosis. In addition, it highlights recent advances in understanding the molecular biology of carcinomatosis and the focus of current and future clinical trials. Finally, this article provides practical management options for the palliation of common complications of carcinomatosis. It is hoped that the reader will recognize that carcinomatosis is no longer an imminent death sentence and that through continued research and therapeutic innovation, clinicians can make an even greater impact on this form of metastatic cancer.
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PMID:Looking up: Recent advances in understanding and treating peritoneal carcinomatosis. 2594 May 94

Pseudomyxoma peritonei is characterized by mucinous ascites originating from a mucin-producing neoplasm; however, even the definition is still under debate. Tumor deposits extend and ultimately engulf the entire cavity, causing death from cachexia due to limited intestinal movement. Here, we report a unique case of an 80-year-old woman with pseudomyxoma peritonei, which extended to the lower extremity mimicking infectious condition. The patient survived for a long time without bowel obstruction despite having the histologic subtype that has an unfavorable prognosis. The extremity lesion was treated with limited extensive surgery. The origin of the disease and the mechanism of extension to the extremity could not be clarified. Clinicians should be aware of the original disease entity and this unusual presentation and determine its mechanism and the best management strategy.
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PMID:Pseudomyxoma peritonei extending to the lower extremity: a case report. 2618 69

Despite significant recent advances in the management of peritoneal carcinomatosis, this diagnosis still is accompanied frequently by a grim survival prognosis, often measured in weeks to months. The poor prognosis also is accompanied often by complications and symptoms that have a dramatic impact on quality of life and are challenging to the managing health care provider and devastating to loved ones caring for the person who is suffering. Consequently, management of carcinomatosis often revolves around palliation of symptoms such as bowel obstruction, nausea, pain, fatigue, and cachexia as well as emotional and existential concerns. This article reviews several palliative treatment options for some of the more common symptoms and complications associated with advanced, incurable peritoneal carcinomatosis. Although readers should recognize that carcinomatosis is no longer an imminent death sentence, providers caring for patients with peritoneal carcinomatosis also must be well-versed in the palliative management of this condition and recognize the utility of early palliative care referral in this setting.
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PMID:Palliative Management of Peritoneal Metastases. 2938 12

Cachexia is a debilitating condition and complex syndrome commonly associated with a variety of chronic diseases. It is caused by metabolic dysregulation and characterized by profound loss of adipose tissue and skeletal muscles. While pathological changes of cachectic conditions on adipose tissue have been studied and documented in tumor-bearing animal models, similar morphological changes in human surgical specimens are rare. Here we report a case of a cachectic patient with pancreatic adenocarcinoma whose adipocytes underwent dramatic lipodystrophy mimicking signet ring cell adenocarcinoma. The patient had presented with a large bowel obstruction, a mass extending between the pancreas and colon, and radiographic concern for carcinomatosis. A moderately differentiated adenocarcinoma was identified invading externally into the colon, with extensive signet ring-like cells throughout the specimen, including those adjacent to the colon and lymph nodes and around nerves. These signet ring-like cells were round with variably clear to eosinophilic cytoplasm and a peripherally displaced round to oval nucleus. Immunohistochemical staining demonstrated that these signet ring-like cells were negative for AE1/AE3, CD138, or Kreyberg staining, while they were positive for S-100 staining, confirming these as dystrophic adipocytes. Here we examine dystrophic adipocytes in a cachetic patient, examining the differential diagnosis and potential ancillary studies.
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PMID:Dystrophic Adipocytes Mimicking Metastatic Signet Ring Cell Adenocarcinoma: A Diagnostic Pitfall in a Cachectic Patient. 2985 30

In cancer patients with tumors of the upper gastrointestinal tract, dysphagia and cachexia require gastrostomy or jejunostomy as the only options for enteral access for long-term feeding. In this article, the authors describe a modified placement of laparoscopic feeding jejunostomy applied during laparoscopic oncology layering technique. After performing an exploratory laparoscopy, a feeding jejunostomy is performed using a Foley silicon catheter, through an eyelet in the mesentery of the descending colon. After completing the introduction of the jejunal probe according to the Witzel technique, the intestinal segment of jejunum is attached to the internal sheath of the mesocolon using sutures polysorb 2/0, with the aim of removing the possible internal hernia and a jejunal torque that could cause an intestinal obstruction. There were no intraoperative complications or mortality. The technique described here provides most of the benefits of laparoscopic jejunostomy feeding, avoiding the possible internal hernia.
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PMID:Laparoscopic surgical transmesocolic jejunostomy: A new surgical approach. 3002 85

An 84-year-old woman with a history of weight loss, anorexia and episodic vomiting was admitted to hospital where she died soon afterwards. Her diagnosis was acute renal injury due to dehydration and malnutrition. At autopsy the body was cachectic with a small intestinal obstruction due to herniation through a defect at the anterolateral aspect of the obturator foramen. A poorly differentiated adenocarcinoma of the gastroesophageal junction was also identified with small peripheral pulmonary thromboemboli. Death was due to small bowel obstruction from a left obturator hernia with scattered peripheral pulmonary thromboemboli complicating cachexia due to gastroesophageal adenocarcinoma. Obturator hernias are called the "little old lady's hernia" and occur mainly in elderly, multiparous and malnourished women. The broader female pelvis and wider obturator canal with laxity of ligaments and loss of preperitoneal adipose tissue padding around the canal predispose to herniation. This rare hernia is often first identified at autopsy.
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PMID:Obturator hernia and the elderly. 3039 70


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