Nutritional problems associated with gastrointestinal and genitourinary cancer.

Cancer involving the alimentary tract may produce signifi cant 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 depni Vation may adversely affect absorptive capacity and contrib ute 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 (â€oecancer 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 develop ment of intestinal lymphoma and carcinoma. Intestinal lym phoma itself can present as a celiac syndrome. The most common direct effect of alimentary tract neoplasms on nu tnitional 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 persist ent vomiting and/or diarrhea. Maldigestion and malabsorp tion may occur as a result of gastric hypersecretion, pan creatic exocnine insufficiency, or bile insufficiency. The malabsorption occurring from these various conditions can lead to deficiencies of a variety of nutrients. Hepatoma may be associatedwith 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. Because of the fundamental roles of the gastrointestinal tract related to ingestion , digestion , and absorption of food, the occurrence of cancer anywhere in that system may produce significant effects on the nutritional status of the patient (Table 1). Included in this system are the entire alimentary tract from the lips to the anus, the liver, gallblad den, pancreas, and the ducts connecting them to the au mentary tract proper. There is a close interrelationship between the function of the components of the gastrointestinal tract and the behav ior of the patient in relation to food and nutrition. In addi tion, there is an important â€oereverse†• relationship between the ability of the patient to consume food in adequate amounts and the subsequent behavior of the gastrointes tinal tract. Itisa dictum inmedicine thatwhen a patienthas an unexplained loss in appetite and body weight one should look for an occult neoplasm. Often such neoplasms are in the gastrointestinal tract. Table 2 summarizes some data on the incidence of weight loss …