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The present review represents an overview of the potential opportunistic use of computerized tomography (CT) to enhance our understanding of abnormal body composition, specifically lean and adipose tissue changes in cancer cachexia.One of the characteristics of cancer cachexia is the depletion of muscle with or without adipose tissue loss. Therefore, a body composition tool that specifically distinguishes between these tissues is essential in assessing this syndrome. Cancer patients are routinely evaluated by high resolution imaging such as CT for the purpose of diagnosis and follow-up. Recent work exploiting CT images for body composition analysis has revealed the natural history of cancer cachexia, including progressive alterations in skeletal muscle, adipose tissue, organs, and tumor mass. CT-based quantification of skeletal muscle has permitted identification of individuals with sarcopenia, and links between sarcopenia and functional status, chemotherapy toxicity, time to tumor progression, and mortality.CT images routinely acquired from health records of cancer patients can be used to quantify specific lean and adipose tissues, to interpret body composition in population-based studies, and to evaluate individual patients in a clinical and therapeutic decision-making setting.