Current cancer therapies – A guide for perioperative physicians

doi:10.1016/j.bpa.2013.09.003

Best Practice & Research Clinical Anaesthesiology

Volume 27, Issue 4, December 2013, Pages 481-492

https://doi.org/10.1016/j.bpa.2013.09.003 Get rights and content

Cancer is expected to be the leading cause of death around the world. New cancer therapies have improved survival but they can also lead to complications and toxicity. In this article, the effects of modern anti-cancer therapies are reviewed. The perioperative effects of chemotherapy, radiotherapy and experimental therapies in relation to anaesthesia are discussed. Common and rare complications are summarised as is advice for optimal treatment of the cancer patient in the perioperative period.

Introduction

It is expected that cancer will be the leading cause of death in the world [1]. Many cancer therapies are available nowadays. New cancer therapies have improved patient survival and they have even turned some malignant diseases, for example, childhood cancers, into a chronic disease [2]. It is pertinent that the physician understands which challenges these therapies can pose perioperatively, compounded by the multiple co-morbidities that cancer patients present with. In the past, some colleagues would summarise surgery for cancer patients as ‘hope for the best, but plan for the worst’. This may still hold true for patients with metastatic disease; however, the prognosis of cancer patients has changed in recent years with novel therapies heralding a new era and paradigm shift in management where one should ‘hope for the best and plan for the best’. For example, before the introduction of the tyrosine kinase inhibitor imatinib at the beginning of this century, the prognosis of patients with gastrointestinal stromal cell tumour (GIST) was very grave. With imatinib, the median survival has increased >5 years [3]. This rapid change in treatments and prognosis should remind the perioperative physician to consult frequently with oncologists who have access to the latest scientific data. This review will focus on cancer therapies that can influence patient care prior, during and after anaesthesia and surgery in the adult population.

Section snippets

Physiological and anatomical effects of malignant disease

A number of conditions that present commonly in cancer patients may have a significant effect on the preoperative, intra-operative and postoperative treatment. These effects can be categorised into physiological and anatomical effects caused by direct effects of the tumour or as effects of therapy for the malignant disease. Tumours that cause anatomic effects of importance to perioperative management include head and neck tumours with airway obstruction, intestinal tumours causing bowel

Perioperative chemotherapy and radiotherapy

Chemotherapy and radiotherapy are common treatments used to treat cancer patients.

These treatments can be given prior to, during or after surgery. Each treatment modality has its own effects, complications and toxicity [7]. The available data on perioperative effects of anti-cancer drugs and radiation therapy will be reviewed. Knowledge about common terms and treatments that are used by oncologists would help the anaesthesiologist to better understand the risks and side effects of these

Hyperthermia

Hyperthermia is used during some chemo- or radiation therapies to optimise the anti-cancer effect. It can be applied locally or systemically. Intra-peritoneal hyperthermic chemoperfusion is a type of hyperthermia therapy used in combination with cytoreductive surgery in advanced abdominal cancers, where warmed chemotherapeutic agents (e.g., Mitomycin-C and cisplatin) are infused and circulated in the peritoneum. When hyperthermic intra-peritoneal chemotherapy is used intra-operatively, with

Emergency surgery or procedures

Surgery in cancer patients may have different goals:

Curative:	performed with the intent to cure,
Preventive:	removal of organs in genetically acquired conditions,
Diagnostic:	biopsy or endoscopy,
Staging:	exploratory surgery to estimate the extent and progression of the disease,
Debulking:	removal of part of the tumour (cytoreduction), often in multiple sessions,
Supportive:	placement of vascular access devices or feeding tubes and reconstructive surgery,
Palliative:	performed to relieve pain, discomfort,

Summary

In the past, some colleagues would summarise surgery for cancer patients as ‘hope for the best, but plan for the worst’. This may still hold true for patients with metastatic disease; however, the prognosis of cancer patients has changed in recent years with novel therapies heralding a new era and paradigm shift in management where one should ‘hope for the best and plan for the best’. Cancer and its treatments can have significant acute and long-term effects on the human body. These effects may

Conflicts of interest

None.

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7Current cancer therapies – A guide for perioperative physicians

Introduction

Section snippets

Physiological and anatomical effects of malignant disease

Perioperative chemotherapy and radiotherapy

Hyperthermia

Emergency surgery or procedures

Summary

Conflicts of interest

Br J Anaesth

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008

Int J Cancer

Cardiac function in 5-years survivors of childhood cancer: a long-term follow up study

Arch Intern Med

Prognosis, imatinib dose, and benefit of sunitinib in GIST: knowing the genotype

JCO

Carcinoid heart disease

Circulation

Anesthesia and pheochromocytoma

Int Anaesthesiol Clin

Anaesthetic implications of chemotherapy

Contin Educ Anaesth Crit Care Pain

Cardiac complications

Phase III trials of targeted anti-cancer therapies: redesigning the concept

Clin Cancer Res

Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis

Eur J Heart Fail

Side effects of ifosfamide

Oncology

Prospective evaluation of major vascular events in patients with nonsmall cell lung carcinoma treated with cisplatin and gemcitabine

Cancer

Chemotherapy-induced peripheral neuropathy

J Neurol

A prospective surveillance model for physical rehabilitation of women with breast cancer: chemotherapy-induced peripheral neuropathy

Cancer

Regional anesthesia and co-existing chronic pain

Curr Opin Anaesth

Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria

Clin Cancer Res

Clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer

JCO

Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3,891 ablations in 2,614 patients

Oncology

Strategies of airway management for head and neck photo-dynamic therapy

Lasers Surg Med

7
Current cancer therapies – A guide for perioperative physicians