Perioperative Effects of Surgery, Anesthesia and Analgesics Associated with Cancer Progression: A Review  - Pages 1-20

Keishla M. García, Karla M. Flores, Adriana Falcón, Charlynne De Jesus, Loida Del Rio, Laura C. Rivera, Michelle Marquez, Santos Ortiz, Gretchen Sandoval, Alejandro Ruiz, Fabiola Rodriguez, Frances Gonzalez, Kenneth Cintron, Miguel J. Berdiel, Jorge Duconge, Maricelly Santiago, Ines Alfaro and Michael J. Gonzalez

DOI: http://dx.doi.org/10.6000/1929-2279.2018.07.01.1
Published: 28 February  2018

Abstract: One of the most common treatments available for cancer patients is surgical removal of the malignant tumor; its long-term implications, however, are still little-known. The purpose of this review is to look at the perioperative effects and determine if there is any correlation between surgery, anesthetics and analgesics, and cancer progression, in the form of cancerous tumor growth and progression and patient survival, within the Puerto Rican population. A retrospective literature review was conducted. Current data suggest that surgery is associated with an increase in cancer proliferation and metastasis, for various reasons such as angiogenesis enhancement and bloodstream migration. Also, it was found that some anesthetics and analgesics have been associated with cancer progression, based on the peri- and postoperative immune status of the patient. Thiopental, ketamine, isoflurane, halothane and some opioids were positively correlated with cancer progression given their role in immunosuppression; while propofol, lidocaine, ropivacaine and bupivacaine were negatively correlated with tumor progression given their immune enhancement. Others, like sevoflurane, nitrous oxide, and etomidate showed inconclusive correspondence. Therefore, it was concluded that immune system boosting anesthetics and analgesics can reduce cancer progression in a patient that has undergone surgical resection. For further research and since the available data are not extensive, other variables such as age, sex, stressors and comorbidities could be considered to better understand the mechanism in which the chemicals hereby studied can cause cancer progression.

Keywords: Anesthetics, analgesics, opioids, cancer, metastasis, recurrence, immunosuppression.

PET/CT and MRI in Evaluating Cervical Cancer
Pages 4-9
Runjun Shi, Jie Chen, Jinchang Wu and Jundong Zhou

DOI: http://dx.doi.org/10.6000/1929-2279.2016.05.01.1

Published: 29 January 2016

Abstract: Positron emission tomography (PET)/computed tomography (CT) and magnetic resonance (MR) imaging are two most important imaging tools for evaluating cervical cancer in clinic. They have improved the accuracy of tumor staging and prognosis predicting in a large part. PET/CT is superior for lymph node (LN) status and metastasis to other imaging modalities. And it could differ among tumor types and grades according to maximum standardized uptake value (SUVmax). MRI is not sensitive to LN metastasis, but it shares the advantage of therapeutic response and recurrence evaluation with PET/CT. Recently, emerging functional imaging modality Diffusion-weighted imaging (DWI) has been showing its superiority on evaluation of cervical carcinoma as well. This article describes both advantages and limitations of MR imaging and PET/CT in evaluating cervical cancer, and reviews the current role of imaging techniques mentioned above.

Keywords: Positron emission tomography, magnetic resonance,cervical cancer, staging, treatment response, recurrence.

Perioperative Management in a Child with Familial Bilateral Pheochromocytoma
Pages 43-46
Saurabh Joshi, Chetan Saraya, Shri Prakash Singh, Jasbir Singh Khanuja and Umesh Kumar Valecha

DOI: http://dx.doi.org/10.6000/1929-2279.2015.04.01.4

Published: 19 February 2015

Abstract: Purpose: Diagnosis and perioperative management of bilateral adrenal pheochromocytoma with a successful outcome is an apt combination of clinical knowledge and anaesthetic skills. Detailed history, meticulous physical examination, relevant laboratory investigations along with good preoperative pharmacological optimization and fluid resuscitation plays an important role in the perioperative period. Genetic testing and counseling should be offered to all the family members of patients suspected of familial predisposition. We report the anesthetic management of 10 year old male child with bilateral adrenal pheochromocytoma with family history of disease.

Clinical Features: A10-year old male, presented to our pediatric outpatient clinic with gradually increasing holocranial headache, blurring of vision, sweating, photophobia, progressive quietness in nature and poor performance in school, increased thirst and urine output for one week along with pain over bilateral lower limbs and difficulty walking without support for 20days. Parents also reported two episodes of generalized convulsions with one episode of opisthotonic posturing and up rolling of eyes, which was sustained for 50 min. Family history of three sudden deaths, and father, a known case of pheochromocytoma along with clinical presentation, raised the suspicion of familial pheochromocytoma.

Conclusion: Though pheochromocytomas are rare tumours, a high level of suspicion in paediatric age group, where patients don’t present with classical symptoms, leads to early diagnosis and management and prevents catastrophic events. Young patients with bilateral disease and positive family history should be offered genetic testing. Preoperative catecholamine blockade and meticulous anaesthetic and surgical management are the keys to successful perioperative management of bilateral pheochromocytoma.

Pharmacotherapeutic Options for Philadelphia Chromosome-Positive CML - Pages 49-58

Atish Patel, Hui Zhang, Deshen Wang, Dong-Hua Yang, Sanjay Dholakiya and Zhe-Sheng Chen

DOI: http://dx.doi.org/10.6000/1929-2279.2018.07.02.3

Published: 16 May2018

Abstract: Chronic myeloid leukemia (CML) is a myeloproliferative disorder of hematopoietic stem cells. Identifying the leading mutation in BCR-ABL that causes CML made it possible to develop a targeted approach against this vastly disseminating disease. The active tyrosine kinase protein of BCR-ABL was effectively blocked with an identified tyrosine kinase inhibitor (TKI), imatinib. Imatinib became the first targeted therapy licensed for patients with chronic-phase CML and its introduction was associated with substantial improvements in response and survival compared with previous therapies. However, drug resistance towards imatinib therapy soon emerged and hence limited the complete eradication of CML in patients receiving imatinib. This is primarily due to the mutations within the ABL kinase domain, and to a lesser degree, due to residual disease after treatment. Nilotinib and dasatinib were soon introduced and showed improved clinical outcomes in patients intolerant and resistant to imatinib treatment. However, the T315I mutant overcame these agents along with imatinib, rendering the treatment ineffective. Exploring the kinase domain of the BCR-ABL protein and identifying key components involved in the signal transduction pathways is crucial towards understanding the disease and developing better strategic approaches towards combating it. In this review, we broadly discuss the current treatment options available against Philadelphia chromosome (Ph) positive BCR-ABL CML. 

Keywords: BCR-ABL, tyrosine kinase, imatinib, nilotinib, dasatinib.