Best practice & research. Clinical anaesthesiology
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The perioperative evaluation of patients with cancer differs from that of other patients in that the former may have received prior chemotherapy or radiation therapy. These cancer treatments have a wide range of side effects and complications that may affect patients' perioperative risks. ⋯ The perioperative specialist must also be familiar with the natural history of cancer and have a basic understanding of how cancer affects the body. In this article, we review the perioperative concerns that are specific to the patient with cancer.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewCurrent cancer therapies - a guide for perioperative physicians.
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. ⋯ 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.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewDoes regional anaesthesia and analgesia or opioid analgesia influence recurrence after primary cancer surgery? An update of available evidence.
Cancer continues to be a key cause of morbidity and mortality worldwide and its overall incidence continues to increase. Anaesthetists are increasingly faced with the challenge of managing cancer patients, for surgical resection to debulk or excise the primary tumour, or for surgical emergencies in patients on chemotherapy or for the analgesic management of disease- or treatment-related chronic pain. Metastatic recurrence is a concern. ⋯ Retrospective analyses have suggested an association between anaesthetic technique and cancer outcomes, and anaesthetists have sought to ameliorate the consequences of surgical trauma and minimise the impact of anaesthetic interventions. Just how anaesthesia and analgesia impact cancer recurrence and consequent survival is very topical, as understanding the potential mechanisms and interactions has an impact on the anaesthetist's ability to contribute to the successful outcome of oncological interventions. The outcome of ongoing, prospective, randomized trials are awaited with interest.
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The global burden of cancer is increasing. By 2020, the global cancer burden is expected to rise by 50% owing to the increasingly elderly population. ⋯ Coordinated, team-based cancer care will be essential to ensure value-based care. Short and long-term outcome measurement is an integral part of the process.
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Best Pract Res Clin Anaesthesiol · Dec 2013
ReviewLymphovascular and neural regulation of metastasis: shared tumour signalling pathways and novel therapeutic approaches.
The progression of cancer is supported by a wide variety of non-neoplastic cell types which make up the tumour stroma, including immune cells, endothelial cells, cancer-associated fibroblasts and nerve fibres. These host cells contribute molecular signals that enhance primary tumour growth and provide physical avenues for metastatic dissemination. This article provides an overview of the role of blood vessels, lymphatic vessels and nerve fibres in the tumour microenvironment and highlights the interconnected molecular signalling pathways that control their development and activation in cancer. Further, this article highlights the known pharmacological agents which target these pathways and discusses the potential therapeutic uses of drugs that target angiogenesis, lymphangiogenesis and stress-response pathways in the different stages of cancer care.