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Unintentional Weight Loss and Malnutrition After Esophageal Cancer and Treatment

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Gastrointestinal Cancers: An Interdisciplinary Approach

Part of the book series: Interdisciplinary Cancer Research ((ICR,volume 4))

Abstract

Patients with esophageal cancer present a management challenge from a nutritional standpoint. Among patients with esophageal cancer, weight loss and nutritional deficiencies are common with nearly 80% experiencing clinically significant (>10%) weight loss at the time of diagnosis. Nutritional complications arise not only as a result of the underlying disease process itself but also due to subsequent medical and surgical treatment. The implications of malnutrition in this patient population should not be underestimated as it has been identified as an independent risk factor in predicting survival and, in some, may either delay or entirely preclude undertaking surgery with curative intent. In patients who do undergo esophagectomy, nutritional compromise is common with approximately a quarter of patients being unable to meet caloric intake targets 1 year postoperatively and nearly one-third losing 15% of their baseline weight by 3 years. The primary causes of weight loss are often attributed to early satiety, dumping, reflux, and dysphagia; however, the underlying pathophysiology is incompletely characterized. Mechanistic studies looking at other operations which induce profound and sustained weight loss including bariatric surgery have provided critical insights into some of the potential mediators involved in weight loss including changes in gut hormones which modulate satiety and appetite via the hypothalamic gut-brain axis. In addition to physiological changes, there are important considerations with regard to alterations in eating behaviors and anatomy. A more complete understanding of the complex interaction between the physiological, psychological, and anatomical changes related to esophageal cancer and treatment may contribute to the development of a patient-centered approach in the management of weight loss and nutritional compromise in both the pre- and postoperative period, including the development of novel pharmaceutical agents to mitigate these changes.

Alexis Sudlow and Annelie Shaw are joint first authors.

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Authors and Affiliations

  1. Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland

    Alexis Sudlow, Annelie Shaw, Clare Corish & Carel W. le Roux

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  1. Alexis Sudlow
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  2. Annelie Shaw
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  3. Clare Corish
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  4. Carel W. le Roux
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Correspondence to Carel W. le Roux .

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  1. Department of Clinical Immunology, Karolinska Institutet, Stockholm, Sweden

    Nima Rezaei

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Sudlow, A., Shaw, A., Corish, C., le Roux, C.W. (2023). Unintentional Weight Loss and Malnutrition After Esophageal Cancer and Treatment. In: Rezaei, N. (eds) Gastrointestinal Cancers: An Interdisciplinary Approach. Interdisciplinary Cancer Research, vol 4. Springer, Cham. https://doi.org/10.1007/16833_2023_142

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