IJPPP Copyright © 2009-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711
Int J Physiol Pathophysiol Pharmacol 2013;5(1):1-10

Review Article
The effects of anesthetics on tumor progression

Lifang Mao, Suizhen Lin, Jun Lin

Department of Anesthesiology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 6, Brooklyn, New York 11203-2098, USA;
Guang-zhou Cellproteck Pharmaceutical CO., Ltd, 3 Lanyue Road, Science City, Guangzhou 510663, P.R China

Received December 18, 2012; Accepted January 26, 2013; Epub March 8, 2013; Published March 18, 2013

Abstract: More and more cancer patients receive surgery and chronic pain control. Cell-mediated immunosuppression from surgical
stress renders perioperative period a vulnerable period for tumor metastasis. Retrospective studies suggest that regional anesthesia
reduces the risk of tumor metastasis and recurrence. This benefit may be due to the attenuation of immunosuppression by regional
anesthesia. On the other hand, accumulating evidence points to a direct role of anesthetics in tumor progression. A variety of
malignancies exhibit increased activity of voltage-gated sodium channels. Blockade of these channels by local anesthetics may help
inhibit tumor progression. Opioids promote angiogenesis, cancer cell proliferation and metastasis. It will be interesting to examine the
therapeutic potential of peripheral opioid antagonists against malignancy. Volatile anesthetics are organ-protective against hypoxia,
however; this very protective mechanism may lead to tumor growth and poor prognosis. In this review, we examine the direct effects of
anesthetics in tumor progression in hope that a thorough understanding will help to select the optimal anesthetic regimens for better
outcomes in cancer patients. (IJPPP1212006)

Keywords: Metastasis, recurrence, regional anesthesia, local anesthetics, voltage-gated sodium channels, opioids, volatile

Address correspondence to: Dr. Jun Lin, Department of Anesthesiology Downstate Medical Center, 450 Clarkson Avenue, Box 6,
Brooklyn, New York 11203-2098, USA. E-mail: jun.lin@downstate.edu