David J. Kerr, CBE, MD, DSc, discusses a patient case related to the controversy of debulking primary disease. MedX
I'm David Kerr, professor of cancer medicine at University of Oxford. Today, let's talk about unintended consequences. I'd like to illustrate this with a patient that we've looked after for many years in the clinic.
It's quite a controversial area, with arguments both for and against this conceptually. There's quite a bit of more recent mouse data suggesting that resection of the primary tumor can cause regression of at least some micrometastases. It's an area of huge controversy, but one that keeps cropping up.
There may be neuroendocrine and paracrine factors. We know that, following any major operation, there can be sweeping changes in levels of cortisol, prostaglandins as part of that pro-inflammatory change, and immune factors. There's a large amount of work done looking at the immediate postoperative changes in the immune system, usually showing it being weakened.
Of course, there's always a possibility of the changes in growth factors, such as increase in tumor necrosis factor alpha postsurgically, decrease in anti-angiogenic factors and endostatin, and increase in pro-angiogenic factors like vascular endothelial growth factor . There's a whole set of plausible circumstances that could be associated with a flare of growth in residual disease.
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