Abstract
Upper gastrointestinal (GI) cancers are responsible for significant mortality and morbidity worldwide. To date, most of the studies focused on the treatments’ efficacy and post-treatment survival rate. As treatments improve, more patients survive long term, and thus the accompanying complications including unintentional weight loss are becoming more important. Unintentional weight loss is defined as >5% of body weight loss within 6–12 months. Malignancies, particularly GI cancers, are diagnosed in approximately 25% of patients who present with unintentional weight loss. Whereas some recent studies discuss pathophysiological mechanisms and new promising therapies of cancer cachexia, there is a lack of studies regarding the underlying mechanism of unintentional weight loss in patients who are tumor free and where cancer cachexia has been excluded. The small bowel is a central hub in metabolic regulation, energy homeostasis, and body weight control throughout the microbiota-gut-brain axis. In this narrative review article, the authors discussed the impacts of upper GI cancers’ treatment modalities on the small bowel which may lead to unintentional weight loss and some new promising therapeutic agents to treat unintentional weight loss in long term survivors after upper GI operations with curative intent.
Highlights
Upper gastrointestinal (GI) cancers include oesophageal, stomach, duodenal, liver, gallbladder, biliary tract, ampulla of Vater, and pancreatic cancers
Malignancies, GI cancers, are diagnosed in approximately 25% of patients who present with unintentional weight loss [13,14,15]
There is a lack of studies regarding the underlying mechanism of unintentional weight loss in patients who are tumor free and where cancer cachexia has been excluded
Summary
Upper gastrointestinal (GI) cancers include oesophageal, stomach, duodenal, liver, gallbladder, biliary tract, ampulla of Vater, and pancreatic cancers. These cancers are responsible for significant mortality and morbidity worldwide [1]. More patients survive long term, and understanding altered gut-brain signaling pathway and unintentional weight loss are becoming more important. If unintentional weight loss after surgery with curative intent is between 10 and 30% from starting weight, long term morbidity and mortality increase even in those in remission of cancer [18,19,20,21,22]. There is a lack of studies regarding the underlying mechanism of unintentional weight loss in patients who are tumor free and where cancer cachexia has been excluded
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