In order to understand why hypoalbuminemia is common in advanced cancer and what causes it, the role of albumin in health and disease is explored. Malnutrition/hypoalbuminemia as a consequence of starvation, stress, and cancer cachexia are contrasted. Cancer-related hypoalbuminemia has been thought to be directly related to the patient's malnutrition. Other obscure tumor-related factors are probably also involved. Hypoalbuminemia in advanced cancer is usually irreversible by ordinary dietary means. In cases where treatment has failed, there may be patient/family problems centering around food. Being realistic, patient autonomy in making decisions about nutrition is advocated.
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