van Eys J
Annu Rev Nutr. 1985;5:435-61. doi: 10.1146/annurev.nu.05.070185.002251.
There are many tumors that have paraneoplastic syndromes. Furthermore, location of certain tumors can result in very specific effects on the host, especially tumors in the hypothalamus, the intestinal tract, or the liver. Finally, tumors of the immune system can have significant distant consequences. However, from direct experimental evidence, from model systems, and from the utilization of nutritional manipulation in the treatment of cancer, the data suggest very strongly that there is no unique cancer malnutrition. Early diagnosed cancer does not show malnutrition as a presenting symptom. Furthermore, all metabolic disturbances can be explained on the basis of the metabolic differences of tumor cells and normal cells and are very frequently proportional to the bulk of the tumor. The cachexia that is associated with malignancies is more likely cachexia in cancer patients than it is a specific cancer cachexia, unless the tumor burden is very large. This point was clearly made in a short review of the causes of cachexia in nearly 1500 cancer patients in Russia (145). Brennan also feels that most cases of malnutrition are uncomplicated starvation, and cancer cachexia has many features seen in major injury or sepsis (16). This distinction has great implications in the management of cancer patients.
有许多肿瘤会伴有副肿瘤综合征。此外，某些肿瘤的位置可对宿主产生非常特定的影响，尤其是下丘脑、肠道或肝脏中的肿瘤。最后，免疫系统的肿瘤可产生重大的远处影响。然而，从直接的实验证据、模型系统以及在癌症治疗中利用营养调控来看，数据非常有力地表明不存在独特的癌症营养不良。早期诊断的癌症不会将营养不良作为首发症状。此外，所有代谢紊乱都可基于肿瘤细胞与正常细胞的代谢差异来解释，并且非常频繁地与肿瘤体积成比例。与恶性肿瘤相关的恶病质更可能是癌症患者的恶病质，而非特定的癌症恶病质，除非肿瘤负荷非常大。这一点在对俄罗斯近1500例癌症患者恶病质原因的简短综述中得到了明确阐述(145)。布伦南也认为，大多数营养不良病例是单纯饥饿，癌症恶病质有许多在重大损伤或脓毒症中可见的特征(16)。这种区分对癌症患者的管理具有重大意义。
