The Cachexia Syndrome in Pancreatic Cancer

Most pancreatic cancer patients are affected by cancer cachexia: a syndrome of severe weight loss, muscle wasting and adipose tissue loss. Several pathophysiological drivers including inflammation, altered protein, glucose, and lipid metabolism, anorexia, malabsorption, and neuro-endocrine changes are thought to underlie the development of cancer cachexia. Having cachexia in pancreatic cancer is associated with a mortality rate of up to 80%. Clinical assessment of body composition, nutritional status, physical fitness, and inflammation are important for (early) detection (and treatment) of cachexia. Many of these assessments can be performed using preoperative diagnostics used in routine care such as abdominal computer tomography scans and blood tests. High pre-operative C-reactive protein levels, increased skeletal muscle fat content (myosteatosis), and low peak oxygen consumption are among the strongest predictors of poor overall survival. Treatment of cancer cachexia remains a challenge as patients can present themselves with many different combinations of symptoms (phenotypes). Therefore, cancer cachexia should be addressed using a personalized multimodal approach, including at least nutritional support, anti-inflammatory drugs and/or immunonutrition, and exercise.