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Nutritional Problems Associated with Gastrointestinal and Genitourinary Cancer¹

Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York 10021

Cancer involving the alimentary tract may produce significant effects on the nutritional status of the patient. The organs in the gastrointestinal system are among the most metabolically active in the body. Consequently, food deprivation may adversely affect absorptive capacity and contribute to malabsorption by its effect on intestinal mucosal enzymes. Mucosal changes associated with malnutrition may occur in the presence of cancers outside the alimentary tract ("cancer enteropathy"), but such changes appear to be the result of and not the cause of cachexia. Long-term preexisting celiac disease is associated with the development of intestinal lymphoma and carcinoma. Intestinal lymphoma itself can present as a celiac syndrome. The most common direct effect of alimentary tract neoplasms on nutritional status relates to partial or complete obstruction at 1 or more sites. In addition to impaired food intake, fluid and electrolyte and acid base problems may result from persistent vomiting and/or diarrhea. Maldigestion and malabsorption may occur as a result of gastric hypersecretion, pancreatic exocrine insufficiency, or bile insufficiency. The malabsorption occurring from these various conditions can lead to deficiencies of a variety of nutrients. Hepatoma may be associated with severe hypoglycemia, and liver failure leads to progressive malnutrition. Ovarian tumors exert an adverse effect with the development of ascites or intestinal obstruction. Cervical and bladder carcinoma may obstruct the ureters causing renal dysfunction.

¹ Presented at the Conference on Nutrition and Cancer Therapy, November 29 to December 1, 1976, Key Biscayne, Fla.