SYSTEMIC MANIFESTATIONS OF TUMORS OF THE SMALL GUT AND LIVER

Tumor-associated Fever in Recurrent Breast Cancer with Liver Metastases

Of 67 patients with recurrent breast cancer accompanied by liver metastases admitted to our facility between January 1990 and August 1993, 8(12%) were found to have tumor-associated fever. We examined the characteristics of these patents. These patients had fever (over 38 degrees C) for more than one week. Their leukocyte counts did not exceed 10000/mm(3), and C-reactive protein (CRP) was below 5 mg/dl in 6 patients. ALL 8 patients had extensive liver metastases. Six patients had massive metastatic lesions, while the remaining 2 had diffuse metastases. Following systemic chemotherapy, 3 patients showed a reduction in tumor size and remission of fever; they remain alive at 14, 16 and 19 months after treatment. Of the remaining 5 patients who did not respond to systemic chemotherapy, 4 died within 6 months. The results of this study suggest that unexplained fever in patients with recurrent breast cancer is closely related to liver metastases.

Anorexia in cancer patients: Prevalence and impact on the nutritional status

One hundred and eightysix cancer patients with different types, site and stage of disease, consecutively admitted to the Istituto Nazionale Tumori, Milan, were examined. The purpose of the study was to assess the prevalence of subjective anorexia and to determine whether some nutrition-related indices are different within homogeneous categories of cancer patients, anorectic and non-anorectic. Anorexia was measured on the basis of an appetite score, evaluated with a visual analogue rating scale. Nutritional intake was evaluated by a computerised programme of the habitual food consumption. Nutritional assessment included anthropometric evaluations (triceps skinfold, arm circumference, arm muscle circumference) and biochemical indices (serum albumin, and total iron binding capacity). A nutritional index was then calculated: GNS = P + I + M x 100, where P: actual weight/premorbid weight; I: actual weight/ideal weight; M: actual arm muscle mass circumference/ideal arm muscle mass circumference. The evaluation of the data showed that: (1) The prevalence of subjective anorexia ranged from 1 3 to 2 5 of the patients depending on the type and site of tumour, and stage of disease. (2) Most of the nutritional-related variables were significantly worse in anorectic compared with non-anorectic patients. (3) Within groups of patients with different tumour location, but homogeneous for the presence or absence of subjective anorexia, there is no difference with respect to nutritional indices; except for patients with cancer of the oesophagus and stomach who were always more depleted. (4) Anorexia did not seem to influence the nutritional status in patients with cancer at an early stage (except in cancer of oesophagus and stomach) but it was associated to malnutrition as the disease progressed to more advanced stages.

Tumor-associated fever in breast cancer

Seventeen breast cancer patients with tumor-associated fever are described. All other potential causes of fever were excluded in each patient, and it was diagnosis of exclusion. Fever was the first manifestation of recurrence in seven patients. In ten patients fever developed in association with new sites of metastases or progression of disease. New sites of metastasis in most of the patients were liver, bone marrow, or lungs. Seven patients had metastatic disease that responded to chemotherapy or hormonal therapy; fever subsided in only these patients (responding group). In nine patients neither tumor nor fever showed response to systemic treatment (nonresponding group). Overall survival after onset of fever was better in the responding group than nonresponding group.