Multiple factors contribute to the weight loss observed in cancer patients [50, 51]. Weight loss can be attributed to the physiologic abnormalities associated with the tumor, such as malabsorption, obstruction, diarrhea and vomiting; these mechanisms are especially significant in patients with GI cancers. Host responses to the presence of a tumor, particularly through the generation of cytokines, can cause anorexia and altered metabolism. Side effects of anti-cancer treatments also contribute to anorexia and GI symptoms [50, 51]. For example, patients receiving radiation to the abdomen or pelvis can develop acute or chronic radiation enteritis, with resultant diarrhea and/or obstructive symptoms. Oral and gastrointestinal symptoms can cause changes in weight early in the course of cancer [52, 53]. Fatigue, depression, anxiety and pain may result in weight loss as well .
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