Monitoring Metastasis and Cachexia in a Patient with Breast Cancer: A Case Study

Abstract

Cachexia, a wasting syndrome associated with advanced cancer and metastasis, is rarely documented in breast cancer patients. However, the incidence of cachexia in breast cancer is now thought to be largely underestimated. In our case report of a breast cancer patient with bone metastasis monitored during the course of her treatment, we document the development of cachexia by image analysis in relation to her metastatic burden. Elucidation of the link between metastatic burden and cachexia could unveil a highly specific screening process for metastasis, by assessing true muscle mass loss. Our patient was a 49-year-old premenopausal woman, with metastatic invasive ductal breast carcinoma in the vertebral and iliac bones on presentation, which progressed with new metastases to her hips, thigh bones, and vertebrae. In the two-year period, that is between her diagnosis and death, she lost >10% of her baseline weight. During these two years, we retrospectively identified a decrease in paraspinal muscle (PM) at the third lumbar vertebra followed by a sharp decline in weight. The increased tumor burden over time in metastatic sites was accompanied by a decrease in abdominal muscle and visceral and subcutaneous fat and was followed by the patient’s demise. The increasing tumor burden in the patient was correlated with the mass of other tissues to determine the tissue that could best serve as a surrogate marker to cachexia and tumor burden. We noted a strong negative correlation between PM area and metastatic tumor area at the third lumbar vertebral level, with PM loss correlating to increasing tumor burden. The monitoring of PM wasting may serve as a marker, and therefore a prognostic factor, for both cachexia and extent of metastatic disease, especially in breast cancer, where metastasis to bone is frequent. Based on our data and review of the literature in this case study, longitudinal monitoring of cachexia in the selected muscle groups can give clinicians early indications of the extent of cachexia in metastatic breast cancer patients.

IL-6 mediated JAK/STAT3 signaling pathway in cancer patients with cachexia

“…Although cachexia is generally observed in pancreatic, gastric, colorectal, lung, and head and neck cancer, recent studies have provided a compelling evidence that there is a relationship between advance metastatic breast cancer and cachexia due to a decrease in muscle mass and excessive weight loss (53)(54)(55). Recent studies have also demonstrated that a high level of IL-6 is associated with cachexia, angiogenesis, atrophy, increased catabolism of muscle protein and resistance to treatment in advance breast cancer (2,35,56).…”

Updates on the pathogenesis of advanced lung cancer‐induced cachexia

“…According to the latest American Society of Clinical Oncology (ASCO) report on clinical research of cancer, there are now 15 million cancer survivors in the United States; that is, one in every 20 Americans has had or is living with cancer. One of the most common problems facing patients with advanced tumors is cancer cachexia . Evidence suggests that more than half of the patients with malignant tumors could progress to the cancer cachexia stage .…”

Physical problems and needs of patients in palliative care center

“…30 Cancer related cachexia is seen in 50-80% of cancer patients with advanced and metastatic disease. 32 Cachexia weakens the body and promotes further spread of cancer. 32 Other most commonly complained physical problem by palliative care patients are: constipation (75%), change of taste (71.7%), lack of concentration (70%) and vomiting (58.3%).…”

“…32 Cachexia weakens the body and promotes further spread of cancer. 32 Other most commonly complained physical problem by palliative care patients are: constipation (75%), change of taste (71.7%), lack of concentration (70%) and vomiting (58.3%). Constipation is very common in palliative care patients and affects more than 50% of patients.…”