ABSTRACT
The degree of malnutrition depends on the type, site and the stage of malignant involve ment.2 Patients with favorable subtypes of non-Hodgkins lymphoma, breast cancer, acute nonlymphocytic leukemia and sarcomas manifest less degree of malnutrition and weight loss (48-61%) compared to patients with unfavorable non-Hodgkin lymphoma, colon cancer, pros tate cancer and lung cancer. On the other hand, patients with esophageal cancer,3 pancreatic and gastric cancer exhibit significant weight loss in 83-87% of cases. As the malignant disease develops and progresses, the metabolic consequences and malnutrition become more evident and severe.3 Patients with most advanced forms of cancer are severely malnourished and fre quently malnutrition and cachexia are the initial manifestations of malignancy.4 Surgical inter ventions, chemotherapy, radiation therapy and other therapeutic modalities in patients with cancer cachexia are associated with significant morbidity and mortality.2,5'7 Reversal of malnu trition and specific nutrient deficiencies with aggressive nutritional support can greatly im prove nutritional status and, therefore, may improve the prognosis in this group of patients.8 The most effective means of provision of nutritional support depends on many factors, chief of them being the location and stage of malignancy. Since patients with cancer, especially those with gastrointestinal cancer, often have obstruction of gastrointestinal tract, food aversion, taste abnormalities, alterations of visceral sensing (early satiety), nausea, vomiting and other metabolic and hormonal abnormalities, it is obvious, that they are unable to maintain their nutritional status with oral intake. Furthermore, surgical interventions, chemotherapy, radiation, and immunotherapy may have significant nutritional and metabolic consequences on these patients. When the use of the gastrointestinal tract becomes ill-advised or impossible, the only means to provide all the nutrients and calories required becomes the parenteral technique in order to attempt to prevent and reverse associated abnormalities in energy, protein, carbohydrate, and fat metabolism, as well as deficiencies of trace elements, vitamins, and other micro nutrients.9
