[Fat Bear Science] Bleeding? Infection? Malnutrition? How do cancer patients manage themselves? This article explains

The main reason why people are afraid of cancer is its high mortality rate. But when it comes to how cancer kills patients, many people may not be able to explain it.

First of all, there is no unified answer to this question. Each patient has different individual conditions, and the final cause of death is also different, generally including:

Infection (47%), the most common of which was lung infection (20%);

Failure of important organs such as brain and liver (25%);

Infarction (11%%) is most common in heart and lung;

Cachexia (10%);

Bleeding (7%), most commonly in the gastrointestinal tract and brain.

The human body has eight major systems: respiratory system, digestive system, circulatory system, motor system, nervous system, endocrine system, urinary system, and reproductive system.

These systems work together to enable the various complex life activities in the human body to proceed normally. Various causes of death caused by tumors in various systems can lead to the death of patients through the common pathway of respiratory and circulatory failure. Among the eight systems, the respiratory, digestive, reproductive, and blood systems have the highest incidence of tumors.

Lung cancer is the most common malignant tumor in the respiratory system. As the tumor grows and fills the lung space, the oxygen exchange capacity of the lung is greatly reduced, and finally the ventilation and gas exchange function of the lung fails. At this time, the patient often shows obvious wheezing or even suffocation. Central lung cancer occurring at the hilum of the lung can cause massive hemoptysis due to the invasion of the tumor into large blood vessels, leading to suffocation or death from hemorrhagic shock.

The most common critical illnesses of digestive system tumors are gastrointestinal bleeding, obstruction, and perforation. Excessive gastrointestinal bleeding can cause hemorrhagic shock, leading to circulatory failure and death.

Digestive tract perforation and obstruction can both cause restricted eating, which, on the one hand, affects the patient's nutritional status, leading to low immunity, increased bed rest time, and increased chance of infection; on the other hand, it can also lead to severe infection and death due to the shift of the patient's intestinal flora.

What are the measures that cancer patients can take to deal with these causes of death from cancer? Let's see what the experts from the Department of Oncology at Chongqing Cancer Hospital have to say.

Ma Huiwen, deputy director of teaching of the Department of Oncology, Chongqing Cancer Hospital, associate chief physician, master of medicine, has been engaged in oncology for more than 20 years and is good at the diagnosis and comprehensive treatment of lung cancer, intestinal cancer, soft tissue malignant tumors, gastric cancer, etc. He has presided over or participated in many scientific research projects in Chongqing.

Lu Songmei, female, Master of Medicine, graduated from Chongqing Medical University with a major in Oncology. She has been engaged in clinical work in oncology for a long time and has published many medical papers.

Self-management of malnutrition

Death from cancer is sometimes not caused by the failure of a certain organ, but rather a system failure. Many cancers, for reasons that are not yet fully understood, can cause patients to lose weight rapidly, with both muscle and fat being lost rapidly, a phenomenon known as cachexia.

Cachexia is a complex disease characterized by chronic, progressive, inadvertent weight loss, often accompanied by anorexia, satiety, and fatigue, and is insensitive or only partially responsive to nutritional therapy.

This process is now basically irreversible, and on this basis, the patient will experience system failure. Cancer patients need to seize the opportunity and intervene in nutrition before they enter the cachexia period in order to delay the occurrence and progression of cachexia.

Reasonable nutritional management can also improve the effectiveness of anti-tumor treatment and the quality of life of patients. Therefore, scientific nutritional intervention can benefit patients more than blindly "avoiding certain foods".

Nutritional intervention for cancer patients can be divided into the perioperative period, radiotherapy and chemotherapy period, and palliative treatment period. Except for some special time periods during hospitalization or some special diseases such as esophageal fistula and intestinal obstruction that require parenteral nutrition support treatment, most cancer patients need to complete their own nutritional intervention. Self-nutrition intervention includes a reasonable diet or oral nutritional formula preparations.

Patients with terminal malignant tumors. According to the consensus of the CSCO Cancer Nutrition Therapy Expert Committee, the goal of nutritional therapy for patients with terminal malignant tumors is to maintain weight, not to increase weight. Excessive supply may increase organ burden; total energy intake and the proportion of thermogenic nutrients for energy supply must be considered at the same time. The concept of low calorie intake is conducive to reducing infectious complications and cost expenditures.

It is generally believed that glucocorticoids and megestrol acetate have a definite effect in increasing appetite. Metabolic regulators that reverse the abnormal metabolism of cachexia should be appropriately selected. Currently used drugs include fish oil unsaturated fatty acids (EPA), docosahexaenoic acid (DHA), etc.

Non-terminal patients. Active nutritional therapy can provide opportunities and guarantees for anti-tumor treatment. Most cancer patients suffer from protein-deficient malnutrition, so the principle of eating should be high-quality protein (animal protein rich in essential amino acids, such as eggs, milk, lean meat, etc.), appropriate carbohydrates, and easy digestion and absorption.

For patients with terminal malignant tumors, high-energy nutritional therapy is not recommended to achieve positive nitrogen balance or nitrogen balance. Only a small amount of food and water is needed to reduce hunger and thirst and maintain water and electrolyte balance.

Self-management of bleeding

Common bleeding conditions in cancer patients include blood in sputum and hemoptysis due to lung tumors, vomiting blood and bloody stools due to the digestive system, bleeding of the skin, mucous membranes, and gums due to blood system diseases or thrombocytopenia after radiotherapy and chemotherapy, and intracranial hemorrhage.

For severe hemoptysis caused by central lung cancer, it is generally caused by tumor invading large blood vessels. In critical cases, it may cause shock or suffocation. Try to avoid severe coughing. Cough slowly and gently to expel old blood clots in the lungs. Avoid excessive tension and cooperate with the doctor for further treatment.

For bleeding caused by the digestive tract, patients should pay attention to their diet, try to eat warm and soft food, chew slowly, and avoid mechanical damage caused by friction between food and the digestive tract wall. When patients have a very poor appetite, they can drink sugar and salt water or electrolyte solution in moderation, which can maintain the basic function of the digestive tract on the one hand, and replenish body fluids, energy and electrolytes on the other.

For bleeding caused by thrombocytopenia, it is necessary to avoid trauma as much as possible and maintain the integrity of the skin mask. For patients with brain metastasis of tumors and thrombocytopenia who are at risk of intracranial hemorrhage, they should be more cautious because intracranial hemorrhage is highly lethal. Patients should avoid emotional excitement and keep their bowels open. At the same time, family members should strengthen their care to prevent patients from falling.

Self-management of infection

Cancer patients have another biggest enemy, which is infection. Especially when the body enters cachexia, the existing antibiotics are ineffective in controlling the infection that has occurred.

When it comes to infection, we must talk about the ways in which infection occurs, including the source of infection, the route of infection, and the susceptible population. Cancer patients often have low immunity, that is, they are susceptible to infection. The basic strategy is to cut off the source of infection, control the route of transmission, and enhance one's own immunity.

Cut off the source of infection, generally try to avoid going to public places, wash hands frequently, and maintain hygiene; bedridden patients need to strengthen skin care, etc. Regarding the route of infection, it is recommended that patients at high risk of infection wear masks to reduce the risk of respiratory infectious bacteria, and pay attention to food hygiene.

Improve your own immunity, including reducing tumor load and strengthening nutrition or using immunomodulators. Tumor cells themselves can cause the body's immune ability to decline, so patients who are in good condition and have indications for anti-tumor treatment such as radiotherapy, chemotherapy and targeted therapy should try to cooperate with doctors to reduce the body's tumor load and further increase the possibility of restoring the body's immunity. Tumor patients can appropriately use immunomodulators to enhance the body's immunity.

The best advice is to take preventive measures to prevent the occurrence of tumors or delay the occurrence of tumors as much as possible. Once diagnosed with a tumor, you should cooperate with your doctor to reasonably arrange treatment at each stage and strengthen self-management.

Should cancer patients exercise?

Some people believe that cancer patients are physically weak and exercise will deplete their physical strength, so they treat cancer patients like babies, taking care of all things for them, not allowing them to move, and just letting them rest.

Some people also believe that cancer patients are physically weak and need more exercise to strengthen their bodies and fight the disease. But in fact, many cancer patients are in poor physical condition, and some even have bone metastasis, which makes them unsuitable for a lot of physical activities.

First of all, the benefits of exercise for cancer patients are not just empty talk, but are supported by the "Guidelines". The American College of Sports Medicine (ACSM) held an expert roundtable meeting, including many scholars in the fields of clinical medicine, oncology, exercise physiology, sports medicine, sports, behavioral science, and epidemiology.

Based on the research evidence at the time, this multidisciplinary team evaluated the safety and benefits of exercise for cancer patients and concluded that exercise is safe and provides many benefits to cancer patients. As a result, the ACSM "Guidelines for Exercise for Cancer Survivors" (hereinafter referred to as the "Guidelines") were developed. According to the requirements of the guidelines, physical activity is very important for restoring the patient's physical strength, and we encourage patients to engage in physical activity so that they can return to their daily lives as soon as possible.

Moderate exercise can speed up the circulation of Qi and blood throughout the body, relieve Qi and blood stasis, and help relieve mental stress and improve mood. Doing everything for cancer patients at home and not allowing them to participate in appropriate exercise outside is equivalent to depriving cancer patients of the precious opportunity to mobilize their own potential and disease resistance.

Therefore, regular exercise for cancer patients can promote metabolism, stimulate the body's immune mechanism, and stimulate the body's natural resistance to disease; it can also suppress negative emotions and increase the joy of life; it can also make people who are usually sick and weak care about their bodies and increase their confidence in life.

Different types of cancer patients should choose different exercise methods:

Patients with respiratory system tumors, such as lung cancer, can restore or enhance lung function by blowing balloons or doing abdominal breathing.

Patients with musculoskeletal tumors, such as bone cancer, often undergo amputation surgery due to their condition. Postoperative exercise should be aimed at restoring motor function. They can practice doing daily tasks with one hand to compensate for the function of the affected limb with the healthy limb.

Exercise for patients with digestive system tumors, such as gastric cancer and intestinal cancer, should be aimed at adapting to new living habits. Appropriate exercise can improve digestive function.

For breast tumors, limb function exercises should be performed early after surgery to restore the joint and muscle functions of the affected limb as soon as possible and to relieve functional disorders caused by limited joint movement, muscle atrophy, scar contracture, edema, etc. of the affected limb after surgery.

Generally speaking, cancer patients are suitable for some exercises with small amount of exercise, controllable rhythm, relatively relaxing and gradual progress. These exercises are good for the limbs and internal organs, and are also very helpful for psychological relaxation and stretching. Regular practice can strengthen muscles and bones, relax muscles and activate blood circulation, please the body and mind, and harmonize qi and blood.

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Reviewer/ Ma Huiwen Lu Songmei Department of Traditional Chinese Medicine Oncology

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Chongqing Cancer Prevention and Treatment Science Popularization Base/Member of China Medical Self-media Alliance

Chongqing Science and Technology Commission Science Popularization Funding Project