Things did not change when all the WL variables and the TNM descriptors were added to the starting equation. Once this message is accepted and the existing variety of the WL definitions recognised, it becomes evident that a consensus agreement on this issue would be highly desirable. As always in clinical medicine, pre-treatment assessment of the lung cancer patient begins with a careful history and physical examination. A detailed history should include the information on the time passed from the first symptom of disease and the weight recorded at that time, while a thorough physical examination cannot omit the measurement of body weight. The above information is all is needed for WL recording in a way that, according to our data, possesses the greatest prognostic significance.
Weight loss is the hallmark of cachexia.
Cachexia is the clinical syndrome characterised by a variety of metabolic derangements and manifested by anorexia, weight loss, and a progressive wasting diathesis. Mechanisms mediating cancer cachexia are multiple 22 . Local tumour effect, altered taste and smell, hypothalamic dysfunction, psychological factors, and antineoplastic therapy may reduce food intake. However, an adequate caloric intake does not abrogate the wasting diathesis, because of multiple alterations in the host intermediary metabolism. The consequences of cancer cachexia are considerable for the patient 23 .