Pre-Cachexia, Cachexia and Refractory Cachexia
Cancer cachexia progresses through three distinct clinical stages, each with increasing severity.
1. Pre-cachexia
This is where the earliest signs appear. Patients may have mild, unintentional weight loss, reduced appetite, and changes in metabolism, especially glucose handling. It’s subtle and often missed, but this stage offers the best chance to intervene.
2. Cachexia stage
This is where the condition becomes clinically obvious. It is defined by involuntary weight loss of more than 5% in six months or more than 2% in patients with a BMI under 20 or clear evidence of muscle loss, also called sarcopenia. At this point, patients experience muscle wasting, weakness, and decreased physical function, and importantly, nutritional support alone cannot reverse the weight loss because of ongoing metabolic and inflammatory changes.
3. Refractory cachexia
Here, the cancer is advanced, and the body’s metabolism is so altered that treatments no longer improve weight or muscle mass. Life expectancy is typically less than three months, and the focus shifts from trying to reverse the process to comfort, symptom control, and quality of life.
In short, cancer cachexia evolves from mild changes that are easy to miss to a metabolic syndrome that resists treatment and finally to an irreversible state where supportive care becomes the priority.