Surgery

Surgery poses many risks to a cancer patient. The known side effects associated with the surgical removal of tumors include anesthesia complications, infections, and immune suppression.

A surgery side effect of concern to cancer patients is that the removal of the primary tumor may directly stimulate cancer spread (the propagation of metastatic lesions). Metastatic tumors require the formation of new tumor blood vessels (called angiogenesis) to grow.

Once the primary tumor has been surgically removed, the amount of endostatin and angiostatin to control new tumor blood vessel growth is drastically reduced, and metastasized lesions begin proliferating out of control. If the immune depression that surgery induces is factored in, the failure of surgery to meaningfully prolong the life of cancer patients becomes quite understandable. Surgery reduces growth control factors (endostatin and angiostatin) while simultaneously weakening the immune surveillance that might be keeping metastatic lesions under some degree of control (Oliver et al. 1996).

Cancer has long baffled medical science. Until recently, scientists did not fully understand why the disease so often begins rapidly spreading throughout the body after surgery. This protocol identifies previously unknown factors involved in the long-term failure of cancer surgeries. The educated patient now has access to drugs to facilitate systemic control of cancer rather than to promote metastasis.

Even more exciting is the news that drugs such as endostatin and angiostatin are in clinical trials. If the FDA approves these drugs, the surgical removal of a large primary tumor might actually "cure" many more cancer patients. In the meantime, there are other anti - angiogenesis drugs that may help prevent the rapid growth of metastatic lesions after the primary tumor is removed.

HOW TUMORS GROW

Almost every tissue in the body derives blood from the thinner-than-a-hair capillaries that lace our tissues. Through capillaries, nutrients, oxygen, and various signaling molecules diffuse into cells. These mechanisms maintain health, fight disease, and allow the body to flourish and grow.
Tumors start out without a vascular circulation. In the early stages of tumor development, they are limited to nutrients that can diffuse from the nearest capillaries. Then, tumors begin to stimulate healthy tissue to make thousands of new blood vessels to supply the cancerous growth--a process called angiogenesis. Without this ability to nourish itself and grow, a tumor cannot enlarge. If the blood supply can be reduced or cut off, the tumor will shrink or die.

REMOVING ONE TUMOR MAY STIMULATE THE GROWTH OF MANY MORE

Recurrence is the point when cancer cells from the primary tumor are detected following the primary treatment for the cancer.

Ipsilateral breast tumor recurrence following conservative surgery and radiation for early stage invasive cancer occurs in approximately 15% of all patients at 10 years and is reduced with surgical excisions which achieve negative margins (Fowble 1999). Local recurrence continues to be a major problem following surgical treatment for rectal cancer, because of the frequency with which it occurs (varying from 4% to 51%), its impact on quality of life, the fact that treatment is rarely successful (McLeod 1997), and the proposed ways of reducing this remain controversial ( McCall et al. 1995).

AVOID ANALGESIC DRUGS THAT PROMOTE METASTASIS

After cancer surgery, the patient often experiences pain and requests an analgesic drug for immediate relief. The drug of choice is often morphine or an other opiates. The problem with these drugs is that they impair immune function, specifically NK activity, lymphocyte-macrophage production, and other key immune cytokines. It is during this postsurgical period that healthy immune function is required to kill cancer cells that have escaped from the primary tumor and are seeking to set up metastatic colonies.

SUMMARY

For many forms of cancer the surgical removal of the primary tumor is crucial if long-term remission is to occur. Anti-angiogenesis drugs given prior to cancer surgery may improve the chances of a long-term remission. These drugs would also theoretically be of value in the post - operative setting, though they may slow the rate of healing.

Surgery suppresses important immune functions needed to kill metastatic tumor cells. The patient should consider taking supplements that enhance immune function.

Avoiding analgesic drugs, such as morphine and other opiates, helps prevent immune suppression and the development of tumor angiogenesis. For pain suppression in the postoperative environment, the drug tramadol may request in lieu of morphine or other opiates.

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