The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

Abstract

: The potential for cancer cells to grow and to metastasize depends on complex interactions between inflammatory signals and pathways, immune cells, and elements of the stromal tissue in which they invade. Related to the nature of many cancers, the probability of recurrence can potentially be quite high for some patients. Immunology, lifestyle modifications, timing of disease, genetics, age, gender, and race are only a handful of ways the likelihood of cancer recurrence can be influenced. The quantity, or density, of certain immunological cells or factors, plays a role in the propagation of cancer cells. Opioids are often used in cancer patients for acute postoperative and chronic pain management. While they can produce significant pain relief, the type of analgesic utilized is important, as it may influence cancer propagation. In this regard, certain opioids have been found to increase T regulatory cells while suppressing NK cell function. Morphine may promote tumor neovascularization and expansion. Fentanyl administration significantly diminishes NK-cells and CD8+ cytotoxic T-cells. In a recent meta-analysis, propofol-based anesthesia improved both cancer-free survival and overall survival. COX inhibitors have also shown promise in persevering cancer immune function, as in literature involving ketorolac and celecoxib. In summary, inhaled anesthesia and opioids may contribute to a pro-tumor metastasis environment also known as cancer propagation; whereas propofol and COX inhibitors may provide a better alternative to reduce cancer recurrence and propagation.

Analgesic treatment for refractory cancer pain caused by gastric cancer bone metastasis: A case report and literature review

“…[34–36] Therefore, dexmedetomidine exerts a therapeutic and preventive effect on serotonin syndrome. [12,13] In the present case, the patient had a combination of neuropathic pain, anxiety, and a history of serotonin syndrome. Therefore, the subsequent selection of dexmedetomidine and sufentanil for analgesia is of great significance.…”

“…[12] Preclinical investigations have suggested promising prospects for COX inhibitors in preserving cancer immune function, possibly providing better options for decreasing cancer recurrence and proliferation. [13] Additionally, celecoxib can reverse immune suppression and counteract the proangiogenic effects of opioid medications in mice. [13] Clinical studies have revealed that the combination of diclofenac or celecoxib with opioid drugs can significantly control bone metastasis-associated cancer pain and that celecoxib can alleviate adverse reactions associated with increasing opioid dosage.…”

“…[13] Additionally, celecoxib can reverse immune suppression and counteract the proangiogenic effects of opioid medications in mice. [13] Clinical studies have revealed that the combination of diclofenac or celecoxib with opioid drugs can significantly control bone metastasis-associated cancer pain and that celecoxib can alleviate adverse reactions associated with increasing opioid dosage. [10,14,15] Therefore, our application of celecoxib as an adjuvant therapy for the initial analgesic treatment of bone metastasis-associated cancer pain is reasonable and has sufficient evidence.…”

Outcomes of intravenous and inhalation anesthesia on patients undergoing esophageal cancer surgery: a retrospective observational study

“…Sevoflurane has been shown to induce T-lymphocyte apoptosis, reduce natural killer (NK) cell activity, reduce Th1 / Th2 ratio, increase tumorigenic cytokines and matrix metalloproteinases (MMPS) levels (key enzymes involved in basement membrane disassembly, thereby promoting tumor dissemination) to systematically damage immune function [ 14 , 15 ]. In contrast, propofol increased the activity of cytotoxic t-lymphocytes, does not inhibit the activity of the NK cells, and reduced the tumorigenic cytokines, has the protective and anticancer effects [ 16 ]. Propofol can also inhibit matrix metalloproteinases, it has the anti-tumor characteristics [ 7 ].…”

The Role of Anesthetic Drugs and Statins in Prostate Cancer Recurrence: Starting at the Actual Knowledge and Walking through a New Paradigm

“…At present, there is concern about the protumor effects that opioids may have [36]. From an oncogenic point of view, opioid receptors have been associated with phenomena such as angiogenesis and neovascularization through various pathways [37].…”