Page 351 - Problem-Based Feline Medicine

18 – THE THIN, INAPPETENT CAT 343

Pathogenesis ● Diagnostic imaging (radiography, ultrasound
examinations and computed tomography) of the
Cancer cachexia is probably the most common
thorax and abdomen.
paraneoplastic syndrome.
– Evaluation of pulmonary neoplasia should
It is associated with a variety of malignancies. include two lateral and ventrodorsal radi-
ographic views.
Although many cats with neoplasia are cachexic, little
● Cytological or histopathological evaluation of tissue
information is available on the metabolic derangements
is required to confirm the diagnosis.
present. Care must be taken extrapolating data from the
dog and man, given the differing nutritional require- Cats with neoplastic lesions should be monitored
ments of these species. closely for evidence of malnutrition. A detailed dietary
history and physical examination are important for
Weight loss occurs in patients with neoplasia because:
monitoring. Regularly assess body weight and use a
● Nutrient intake is reduced.
body condition scoring system.
– This is related to tumor size and location. For
example, intraoral masses cause dysphagia, and Hematological and biochemical parameters are rela-
infiltrative intestinal neoplasia may reduce nutri- tively insensitive markers of nutritional status, but may
ent assimilation. provide additional information. However these markers
– Decreased appetite may be a consequence of may be affected by the neoplasia itself.
therapy. ● Creatine kinase concentrations may increase rap-
● Metabolic and hormonal changes secondary to idly in response to anorexia.
neoplasia lead to inefficient energy utilization. ● Protein malnutrition may lead to hypoalbuminemia.
● Malnutrition may also cause anemia and lym-
phopenia.
Clinical signs
Inappetence and weight loss are common clinical Differential diagnosis
findings in many cats with varying malignancies.
Differential diagnoses include most causes of inappe-
Weight loss is frequently associated with muscle wast-
tence and weight loss.
ing, and consequent lethargy and weakness.
Other differentials to be considered depend on the site,
Poor hair coat, delayed wound healing and impaired
location and nature of the tumor.
immune function are associated with cachexia.
Other clinical signs will vary with the nature and loca- Treatment
tion of the neoplasia.
Treatment specific to the neoplastic lesion will depend on
the nature, extent and location of the tumor, but may
Diagnosis
include excisional surgery, radiotherapy or chemotherapy.
Neoplasia should be suspected in any cat showing
Dietary recommendations postulated to prevent or ame-
inappetence and weight loss, with no obvious other
liorate cancer cachexia include:
cause.
● Palatable, highly digestible, complete and bal-
A thorough clinical examination, including palpation of anced diets.
all lymph nodes, may provide an indication of the site ● Tumor cells have an obligate requirement for glucose
of the lesion and direct further investigation. and are unable to utilize significant amounts of lipid
for energy. Therefore, energy-dense diets, which are
Principal diagnostic efforts are aimed at establishing
relatively high in fat and restricted in carbohydrate,
the nature and extent of the neoplastic lesion. The
may theoretically have beneficial effects.
exact diagnostic investigation will depend on the loca-
tion and type of lesion being investigated but may Appropriate treatment of associated symptoms such as
include: nausea, diarrhea or vomiting.