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Perioperative Care of the Cancer Patient: Breast Procedures

Background In the United States breast cancer is the most commonly diagnosed cancer in women and accounts for over 260,000 new cases each year. A woman living in the United States has a 12% lifetime risk of being diagnosed with breast cancer. Although mortality rates have been declining, it is the second most common cause of death in women and responsible for over 40,000 deaths. Risk…

Perioperative Care of the Surgical Patient: Heart, Lung, and Mediastinum Procedures

This chapter consists of three major sections, each of which addresses different aspects of the perioperative management of cancer patients requiring thoracic surgery. Over the last decade, the field of thoracic surgery has advanced in many ways, for example, the rise of minimally invasive surgery, the introduction of immunotherapy drugs, and a growing trend toward standardization of care with enhanced recovery protocols. With these advancements, this…

Anesthesia for Head and Neck Cancer Surgeries

Introduction Head and neck malignancies are a heterogeneous group of malignancies extending from the upper aerodigestive tract up to the larynx, including the thyroid gland, salivary glands, and paranasal sinuses. They account for more than 650,000 cases worldwide. Considering the current burden of head and neck malignancies and increasing survival, most anesthesiologists would be faced with providing anesthesia to these patients for both oncologic and nononcologic…

Anesthesia for Spine Cancer Surgery

Introduction Spinal cancer is primarily a metastatic disease with >90% having originated from another source. , In addition, osseous spread is the third most common form of metastasis with 30%–70% of cancer patients encountering spinal metastasis. Many primary tumors affect persons of advanced age, with more than 60% of cancer patients being older than 65 years. Consequently, particular consideration for comorbidities, fitness for therapy, and patient…

Perioperative Care of the Surgical Patient: Brain

Introduction Cancer of the central nervous system is the 10th leading cause of death in the United States. An estimated 23,820 adults and 3720 children under the age of 15 years will be diagnosed with a primary tumor of the brain or spine in 2019. Primary tumors from the lung, breast, kidney, and bladder, and melanoma, leukemia, and lymphoma frequently metastasize to the brain, creating a…

Procedural Care of the Adult Cancer Patient Outside of the Operating Room

Introduction The cancer patient often requires complex diagnostic, therapeutic, and palliative care procedures in nonoperating room (non-OR) sites, which has created an increasing demand for anesthesia services in remote locations outside of the traditional operating room (OR). Remote areas requiring anesthesia continues to expand, and anesthesia services are now frequently requested for endoscopy, diagnostic radiology, interventional radiology (IR), radiation oncology, nuclear medicine, as well as for…

Airway Management in Special Situations

Special situations in cancer airway management, including unexpected difficult tracheal intubation, airway bleeding, and extubating a difficult airway, are major challenges in cancer airway management. Although the majority of airway events are managed uneventfully, failure of airway management occurs despite the application of various techniques and leads to fatal outcomes, emphasizing the importance of situation awareness, preparing for unexpected difficulties, appropriate working environment, and team collaboration.…

Redesign of Perioperative Care Pathways

Introduction Patients follow a journey through time when they progress from the first symptoms or screening tests, through investigations and receiving a new diagnosis of cancer, to the initiation of treatment and beyond. The notions of “survivorship” and “living with and beyond cancer” encapsulate the changing face of this journey and emphasize the chronicity of experience that people with cancer now have. Increasingly effective cancer treatments…

Functional Assessment and Prehabilitation

The Physiologic Impact of Cancer and Surgery on Patient Function As the volume and complexity of surgical procedures will increase in the next decades, the age and number of associated comorbid conditions of patients presenting for these procedures is also projected to rise. In this context, preventative strategies aimed at reducing postoperative complications by mitigating the stress response to cancer and surgery before it occurs is an…

Preoperative Evaluation and Medical Optimization of the Cancer Patient

Introduction Although many of the goals of preoperative evaluation and optimization are the same for patients with and without cancer, cancer patients present a unique set of challenges that perioperative physicians must be familiar with. The overall goals of preoperative evaluation are to understand the whole patient, identify undiagnosed or undertreated conditions, and acknowledge patient- and procedure-related risk factors in order to prepare the patient optimally…

Can Regional Anesthesia and Analgesia Influence the Risk of Cancer Recurrence?

What Is Regional Anesthesia? Regional anesthesia may be defined as the administration of local anesthetic drugs around a nerve or plexus of nerves, or anatomical plane through which nerves pass, in order to render a distal site anesthetized. It can be used in conjunction with general anesthesia (GA), or it can be the sole means of anesthesia, thereby sometimes allowing the patient to be fully awake…

Opioids and Cancer

Introduction Cancer is the second leading cause of death globally, accounting for approximately 9.6 million deaths in 2018. The impact of cancer morbidity is significant and continues to rise, with an annual cost of approximately US$1.16 trillion in 2010. There has been significant research in cancer therapeutics and identification of the causes of cancer. Despite the availability of more than 500 drugs to treat various cancers,…

Volatile and Intravenous Anesthetics and Cancer

General Introduction: Anesthesia and Cancer Progression Surgery remains a central treatment modality for patients with solid cancers, with more than 60% of cancer patients presenting for surgical resection, and more than 80% of cancer patients exposed to a surgical procedure during their treatment journey. , Together with a rapidly growing and aging population, it is estimated that in 2030 17.3 million cancer patients will need surgery…

Local Anesthetics and Cancer

The Perioperative Period Is Critical for Postsurgical Cancer Outcomes Surgery is the primary and often the most effective treatment for many solid tumors. However, even otherwise successful surgeries may disrupt and disseminate tumor cells. Disseminated tumor cells increase the risk of recurrence and metastasis. Indeed, the number of postsurgical circulating cancer cells is a negative prognostic indicator of disease-free survival. A number of prometastatic events occur…

Improving Cancer Survival Through Perioperative Attenuation of Adrenergic-Inflammatory Signaling

The Perioperative Period—An Underutilized “Window-of-Opportunity” to Prevent Metastatic Disease The occurrence of metastatic disease is the leading cause of death in most patients with cancer. Accumulating evidence suggests that the perioperative period, days to weeks before and after surgery, is a critical time frame in which multiple factors profoundly affect initiation, progression, and/or elimination of metastases, providing a critical window of opportunity to prevent metastatic disease.…

Anemia, Thrombosis, Transfusion Therapy, and Cancer Outcomes

Introduction As surgical and anesthetic techniques have evolved, perioperative mortality in complex cancer surgical interventions has decreased significantly. However, complications and associated morbidity remain a challenge not only for surgical recovery, but also for functional restoration, completion of care for the patient, and long-term cancer outcomes. As such, optimization and preparation for major cancer surgery (prehabilitation) should be a high priority safety initiative and a fundamental…

Personalized Cancer Care

Introduction The management of cancer patients has evolved exponentially over time. At the start of the 19th century surgery was the only available modality to treat cancer, and surgery itself was limited to superficial tumors such as breast and skin cancer due to the lack of anesthesia and the risk of sepsis. This resulted in surgery being a hazardous undertaking and the speed of surgery being…

Cancer and Heart Disease

Introduction At the intersection of oncology and cardiology, the field of cardio-oncology is growing primarily with the aim of recognizing, monitoring, and treating cardiovascular complications resulting from cancer-related treatments. With advances in cardiac imaging technologies, we now have a much better understanding of the cardiac effects of cancer and cancer therapies; and are refining therapies in the subspecialty of heart failure (HF). Although a number of…

Newer Cancer Therapies and Perioperative Implications

Introduction There have been rapid and substantial advances in cancer treatment with improved systemic therapies, including chemotherapy, hormone therapy, targeted therapy, and immunotherapy, as well as recent technologic advances in radiation therapy. This has led to new combinations and sequences of cancer treatment, including the use of neoadjuvant and adjuvant therapies in surgical patients. Therapeutic advances in cancer treatments have significantly improved outcomes for many malignancies…

Traditional Cancer Therapies and Perioperative Implications

Introduction Preoperative cancer therapies such as chemotherapy and radiation can have direct implications on perioperative management during cancer surgery. Chemotherapy is intended to prevent proliferation of malignant cells (cytostatic) and cause death of tumor cells (cytotoxic). It can be given at various stages during cancer treatment, including before surgery (neoadjuvant), after surgical resection (adjuvant), or as palliative therapy to improve quality of life. Chemotherapy is usually…