7Current cancer therapies – A guide for perioperative physicians
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.
References (39)
- et al.
Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours
Br J Anaesth
(2001) - et al.
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
Int J Cancer
(2010) - et al.
Cardiac function in 5-years survivors of childhood cancer: a long-term follow up study
Arch Intern Med
(2010) Prognosis, imatinib dose, and benefit of sunitinib in GIST: knowing the genotype
JCO
(2008)- et al.
Carcinoid heart disease
Circulation
(2007) - et al.
Anesthesia and pheochromocytoma
Int Anaesthesiol Clin
(2011) - et al.
Anaesthetic implications of chemotherapy
Contin Educ Anaesth Crit Care Pain
(2012) - et al.
Cardiac complications
- et al.
Phase III trials of targeted anti-cancer therapies: redesigning the concept
Clin Cancer Res
(2013) - et al.
Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis
Eur J Heart Fail
(2002)
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
Cited by (12)
pH-sensitive carboxymethyl chitosan hydrogels via acid-labile ortho ester linkage as an implantable drug delivery system
2019, Carbohydrate PolymersCitation Excerpt :Surgery is a primary treatment for many types of cancer (ovarian or gastrointestinal cancers for example), usually followed by adjuvant chemotherapy (Konishi et al., 2003). Chemotherapeutic agents, however, have several inevitable shortcomings, including poor stability, low tumor accumulation, and systemic toxicity (Chen et al., 2017; Huitink & Teoh, 2013; Liu et al., 2017). In order to maximize the chemotherapy effect, the most important challenge is to deliver sufficient amounts of drugs to tumor tissue for a long time period (Su et al., 2017).
Carboxymethyl chitosan-based nanogels via acid-labile ortho ester linkages mediated enhanced drug delivery
2019, International Journal of Biological MacromoleculesCitation Excerpt :Chemotherapy is still widely used to treat malignant tumor, but the chemotherapeutic drugs used in clinical usually cause inevitable side effects and system toxicities because of the poor pharmacokinetics, low tumor accumulation and significant off-target localization [1–4].
Nanoparticles for tumor targeting
2017, Biopolymer-Based Composites: Drug Delivery and Biomedical ApplicationsCucurbitacin-I induces hypertrophy in H9c2 cardiomyoblasts through activation of autophagy via MEK/ERK1/2 signaling pathway
2016, Toxicology LettersCitation Excerpt :Cancer remains an important public health concern in the world (Ramaswami et al., 2013). Although surgical resection and radiation remain the most common strategy for cancer therapy, anticancer agents are equally important for its convenient and efficient when used alone or in combination with surgery or radiotherapy (Huitink and Teoh, 2013; Saijo et al., 2003). Therefore, developing new effective anticancer drugs is still an important strategy in tumor therapy (Saijo et al., 2003).
Nanoparticle therapeutics: Technologies and methods for overcoming cancer
2015, European Journal of Pharmaceutics and BiopharmaceuticsCitation Excerpt :Chemotherapy can be given neoadjuvantly before surgery to shrink tumour size, adjuvantly after surgery to prevent metastasis, or concurrently with radiotherapy of hormonal therapy [15]. Cytotoxic drugs used in chemotherapy target labile, or rapidly dividing cells, and do not distinguish between healthy labile cells such as bone marrow, gastric mucosa lining, and skin cells [15–17]. It is given at the maximum tolerated dose (MTD), resulting in dose limiting toxicity, debilitation, which interferes with the effective treatment dose (as often the dose must be lowered).
Black Phosphorus Nanosheets Induced Oxidative Stress in Vitro and Targeted Photo-thermal Antitumor Therapy
2021, ACS Applied Bio Materials