When the air hits it.
Top Line: If there’s a small localized breast cancer, the answer is almost always to cut it out. But can this have unanticipated systemic repercussions?
The Study: The old wives’ tale of cancer spreading precisely because it was operated upon is now being supported by none other than Harvard-affiliated clinicians and scientists. Their argument goes like this: many women with clinically localized breast cancer actually have micrometastatic disease being held at bay by a complex milieu of CD8+ T cells and other immune modulators (we see you, Bernie). Then, the trauma induced by a local surgery incurs a systemic inflammatory response that disrupts this delicate balance, allowing these subclinical metastatic deposits to flourish into full-blown macromets. To prove this concept, they injected both tumor cells and a sponge (yes, it was intentionally left behind) into hundreds of mice. Then, at a later time, they surgically excised the sponge in a portion of mice and observed distant tumor growth. Remarkably, tumor growth occurred in 60% of mice undergoing spongectomy and only 10% of mice who didn’t. Their hypothesis was further supported by a strong uptick in circulating monocytes following surgery as well as a significant decrease in distant tumor size with administration of peri-operative meloxicam.
Bottom Line: Surgery can have the opposite of an abscopal effect, at least in murine cancer subjects, but something as easy as peri-op NSAIDs can ameliorate it. | Krall, Sci Trans Med 2018
The Study: The old wives’ tale of cancer spreading precisely because it was operated upon is now being supported by none other than Harvard-affiliated clinicians and scientists. Their argument goes like this: many women with clinically localized breast cancer actually have micrometastatic disease being held at bay by a complex milieu of CD8+ T cells and other immune modulators (we see you, Bernie). Then, the trauma induced by a local surgery incurs a systemic inflammatory response that disrupts this delicate balance, allowing these subclinical metastatic deposits to flourish into full-blown macromets. To prove this concept, they injected both tumor cells and a sponge (yes, it was intentionally left behind) into hundreds of mice. Then, at a later time, they surgically excised the sponge in a portion of mice and observed distant tumor growth. Remarkably, tumor growth occurred in 60% of mice undergoing spongectomy and only 10% of mice who didn’t. Their hypothesis was further supported by a strong uptick in circulating monocytes following surgery as well as a significant decrease in distant tumor size with administration of peri-operative meloxicam.
Bottom Line: Surgery can have the opposite of an abscopal effect, at least in murine cancer subjects, but something as easy as peri-op NSAIDs can ameliorate it. | Krall, Sci Trans Med 2018
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