Difficulties in Improving Physical Performance in Cachexia Caused by Thoracic Cancer

Elisa Giovannetti^*
*Correspondence: Elisa Giovannetti, Department of Medical Oncology, University of Pisa, Pisa, Italy, Email:

Introduction

Cancer cachexia is a hypercatabolic state that frequently occurs in newly diagnosed advanced lung cancer. It is associated with malignant tumors. A serious effect of cancer cachexia is a clinically significant decline in physical performance, especially in the elderly population; nevertheless, there are currently no pharmacological or non-pharmacological treatments that can mitigate or prevent this crucial outcome. Athletes' and sarcopenics' physical performance was found to be improved by multimodal interventions that combine exercise, nutritional advice, and the best protein supplementation. As a result, it has been suggested that this combination could be used to treat cancer cachexia. However, there is still a lack of evidence regarding the exercise counterpart, despite the fact that oral nutritional supplement advice was somewhat standardized and was shown to increase weight in cancer cachexia.

SMAD has been found to be abnormally expressed in a variety of tumors, including prostate, gastric, and breast cancers. Overexpression of the SMAD protein is associated with a lower colorectal cancer survival rate and an increase in SMAD protein expression. Kleeff and co. report that pancreatic cancer has a higher level of SMAD expression than the normal pancreas. In nude mice, the pancreatic cancer cells that were transfected with SMAD were found to be more malignant and to be more capable of growing tumors. This suggests that the abnormal expression of SMAD will play a role in the growth of tumors. However, the outcomes of some studies have varied. Transfection of the SMAD antisense gene has been reported to have the potential to prevent TGF beta from promoting growth. There aren't many studies on the role of SMAD in lung cancer onset, progression, invasion, and metastasis at this time.

Description

Through a 4 cm right lateral thoracotomy at the fourth intercostal space between the middle and anterior axillary lines, the surgical procedure was carried out using a uni-VATS approach. To enable selective ventilation of the left lung, the patient received general anesthesia and a double lumen endotracheal tube. To begin, our goal was to perform a segmentectomy to preserve the functional lung parenchyma. Unfortunately, the upper lobe had diffuse emphysema replaced, so a RUL lobectomy with dissection of the II, IV, VII, and VIII mediastinal node stations was performed. The mediastinal adipose tissue was removed together with the thymectomy the second time around. Two 24 Fr chest drains were inserted instead of CO₂: The first was inserted into the pleural space via the mini-thoracotomy access, and the second was inserted into the mediastinal space via the sixth right intercostal space anteriorly. Without significant blood loss, the operation lasted approximately 200 minutes. For histological diagnosis, the specimens were sent to the pathology department.

In neo-adjuvant radiotherapy and chemotherapy for esophageal cancer, a new generation of chemotherapy drugs like paclitaxel, docetaxel, and rituximab was used after the 1990’s. Both cumulative and tumor free survival were found to be unaffected by histology, performance status, age, or treatment regimen in the Thirion metaanalysis. However, a systematic review of the chemotherapy regimens used in the neo-adjuvant treatment of esophageal cancer was published. The effectiveness of platinum plus paclitaxel and platinum plus 5 fluorouracil was compared based on the OS rate. The survey presumed that neo-adjuvant chemo-radiotherapy with paclitaxel in addition to platinum was a superior therapy for privately progressed esophageal disease than platinum in addition to 5‐FU, particularly in patients with squamous cell carcinoma. However, the evaluation of the efficacy of neo-adjuvant chemotherapy will be affected by a variety of factors, including the patient's age, the type of pathology, the radiotherapy plan, the surgical procedure, and the dose of chemotherapy, the number of cycles of chemotherapy, neo-adjuvant therapy, and the interval between surgeries. For these findings to be confirmed, a massive randomized controlled trial is required.

In addition, the patient was given the diagnosis of MSSA-caused Mycotic Aortic Aneurysm (MAA). MAAs is uncommon infections related aortic aneurysms. With hospital mortality rate of 23.5 percent-37 percent and accounting for 0.5%-1.3% of all aortic aneurysms, this condition has a poor prognosis. Septic emboli, bacteremic seeding of an existing intimal injury and atherosclerotic plaque are just a few of the pathways that can lead to infection of the arterial walls. Other possibilities include a dentist's physical examination revealed dental caries in this instance, which necessitated tooth extraction. As a result, the gingival sulcus served as the entry point for the diagnosis of MSSA sepsis on the patient. Along with sepsis, S. aureus is also known to frequently cause organ abscesses.

Prior to deciding on surgical repair, we therefore performed a lymphatic intervention and lymphangiography on POD. Under ultrasound, G needle was used to puncture a right inguinal lymph node, and 5 milliliters of Lipiodol (ethiodized oil; under fluoroscopy, Guerbet) was slowly injected. After representation of cisterna chyli and the thoracic channel inside 20 min, a needle cut of the thoracic pipe through a percutaneous transabdominal course empowered catheterization for lymphatic mediation. Thoracic ductography utilizing a microcatheter uncovered a flawless thoracic conduit; however, a tributary that had leaked contrast media was observed in the surgical area where mediastinal lymph nodes had been dissected. A lymph node map in the seventh TNM classification shows that these lymph nodes are related to the para and subaortic nodes. Eminently, this feeder, named a bronchomediastinal lymph trunk, was displayed to join the thoracic channel before its venous end. Four microcoils were used to embolize this tributary, and then N-butyl cyanoacrylate and Lipiodol were injected into it. The embolization and lymphangiography procedures took each 40 minutes.

Conclusion

The most important outcome of cancer cachexia treatment might be a longer, more active life with a high quality of life. However, as the anamorelin trials demonstrated, the standard endpoint in cachexia trials increasing lean body mass may not always contribute to an ultimate endpoint. In addition, when used on their own, each component of the intervention such as medication, exercise, or die is insufficient to improve cancer cachexia patients' physical function. As a result, using a tri-combination strategy, it is the right time to try to improve the physical performance of cancer cachexia patients and improve the quality of their care.