Cancer

Question 1

What are the 5 most common types of cancer? What are the 5 most likely to kill you?

Answer 1

Incidence

• lung 11.6%
• breast 11.6%
• colorectal 10.2%
• prostate 7.1%
• stomach 5.7%

Mortality

• lung 1.8mil 18.4%
• colorectal 881,000 9.2%
• stomach 8.2% 762
• liver 9.2% 762000
• breast 6.6%

Question 2

What are some disease specific challenges for those with cancer?

Answer 2

Underlying causative risk factors (smoking, obesity)

Adverse effects of therapy (chemo, immuno, radiotherapy)

local mass effects

Organ impairment from mets

Reduced physiologic capacity

Question 3

How can cancer be progressed in the perioperative period?

Answer 3

surgery can cause physiological stress/pain/inflammation/immune suppression, negative nitrogen balance and insulin resistance.

• hypoxia
• growth factor release
• inflammation
• angiogenesis
• immunosuppression

creates an environment to 1) support recurrent and 2) metastasis

micrometastasis are expanded in proangiogenic environment, tumour shedding and immunosuppression

Question 4

What are some methods to reduce cancer recurrence?

Answer 4

Time to return to intended oncologic therapy (RIOT)
- adaptation in anaesthetic technique

Number of post op complications increases with number of post op days

Question 5

What are some things you can do prior to surgery?

Answer 5

• prehabilitation (e.g. improve whole body exercise capacity, haematinic screen, nutrition state, strength training)
  i. e. optimise preop reserve.

Question 6

What are some surgical factors that you can use to decrease risk of cancer recurrence?

Answer 6

• spinal compared to GA reduced the risk of chemical metastases
• 20 publications - retrospective post hoc trials.
• mortality aide but not recurrence 3b evidence

so not sure yet
- inflammatory response (cortisol, insulin) not covered by type of surgery

we need to modulate inflammatory response

1) complete resection
2) margin free resection
3) minimal residual disease
4) expedite surgery
5) gentle tissue handling
6) minimal blood loss

Question 7

What are some peri-operative strategies for cancer patient?

Answer 7

RIOT (return to intended oncologic therapy)

• adjuvant therapy and complete treatment course
• major factors (post op complications, fatigue)

symptom burden correlates to inflammation

PROMPT studies: 
Preop 
- pregabalin 
- celecoxib, 
- tramadol, 
- IV acetaminophen 

Intraop

• IV technique with epidural blocks
• normothermia, euglycemia, goal directed fluid therapy, permissive hypercapnia

Post op

• regional block
• opoid sparing strategies

Opioid sparring and volatile free anaesthetic