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Which of the following phenomena best accounts for the patient’s anorexia and cachexia?

The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient’s anorexia and cachexia?
Inadequate cellular metabolism of glucose results from tumor factors
High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting
Products of the tumor itself as well as a hypermetabolic state cause cachexia
Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat

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