Immunomodulatory Effects of Surgery, Pain, and Opioids in Cancer Patients

Vet Clin North Am Small Anim Pract. 2019 Nov;49(6):981-991. doi: 10.1016/j.cvsm.2019.07.008.

Abstract

Surgery is the mainstay of therapy for canine and human solid cancers. Alarmingly, evidence suggests that the process of surgery may exacerbate metastasis and accelerate the kinetics of cancer progression. Understanding the mechanisms by which cancer progression is accelerated as a result of surgery may provide pharmacologic interventions. This review discusses surgery-induced cancer progression. It focuses on immunomodulatory properties of anesthesia and opioids and evidence that studies evaluating the role of opioids in tumor progression are indicated. It concludes by discussing why companion animals with spontaneously arising cancer are an ideal model for clinical trials to investigate this phenomenon.

Keywords: Cancer; Immunomodulation; Opioids; Palliative care; Perioperative immunosuppression.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Animals
  • Disease Progression
  • Dog Diseases / drug therapy*
  • Dogs
  • Neoplasm Metastasis
  • Neoplasms / complications
  • Neoplasms / drug therapy
  • Neoplasms / surgery
  • Neoplasms / veterinary
  • Pain / drug therapy
  • Pain / veterinary*
  • Pain Management / methods
  • Pain Management / veterinary*
  • Postoperative Complications / prevention & control
  • Postoperative Complications / veterinary

Substances

  • Analgesics, Opioid