Lee Susannah K, Dawson Jill, Lee Jack A, Osman Gizem, Levitin Maria O, Guzel Refika Mine, Djamgoz Mustafa Ba
Pomona College, Claremont, CA, USA.
Healthcare Communications Consultancy, Danville, CA, USA.
Int J Gen Med. 2014 Jan 7;7:49-58. doi: 10.2147/IJGM.S42187. eCollection 2014.
In this review, the first of two parts, we first provide an overview of the orthodox analgesics used commonly against cancer pain. Then, we examine in more detail the emerging evidence for the potential impact of analgesic use on cancer risk and disease progression. Increasing findings suggest that long-term use of nonsteroidal anti-inflammatory drugs, particularly aspirin, may reduce cancer occurrence. However, acetaminophen may raise the risk of some hematological malignancies. Drugs acting upon receptors of gamma-aminobutyric acid (GABA) and GABA "mimetics" (eg, gabapentin) appear generally safe for cancer patients, but there is some evidence of potential carcinogenicity. Some barbiturates appear to slightly raise cancer risks and can affect cancer cell behavior in vitro. For cannabis, studies suggest an increased risk of squamous cell carcinoma of the tongue, larynx, and possibly lung. Morphine may stimulate human microvascular endothelial cell proliferation and angiogenesis; it is not clear whether this might cause harm or produce benefit. The opioid, fentanyl, may promote growth in some tumor cell lines. Opium itself is an emerging risk factor for gastric adenocarcinoma and possibly cancers of the esophagus, bladder, larynx, and lung. It is concluded that analgesics currently prescribed for cancer pain can significantly affect the cancer process itself. More futuristically, several ion channels are being targeted with novel analgesics, but many of these are also involved in primary and/or secondary tumorigenesis. Further studies are needed to elucidate possible cellular and molecular effects of orthodox analgesics and their possible long-term impact, both positive and negative, and thus enable the best possible clinical gain for cancer patients.
在本综述（共两部分，此为第一部分）中，我们首先概述了常用于对抗癌痛的传统镇痛药。然后，我们更详细地研究了镇痛药使用对癌症风险和疾病进展潜在影响的新证据。越来越多的研究结果表明，长期使用非甾体抗炎药，尤其是阿司匹林，可能会降低癌症的发生率。然而，对乙酰氨基酚可能会增加某些血液系统恶性肿瘤的风险。作用于γ-氨基丁酸（GABA）受体的药物和GABA“模拟物”（如加巴喷丁）对癌症患者似乎总体安全，但有一些证据表明存在潜在致癌性。一些巴比妥类药物似乎会略微增加癌症风险，并能在体外影响癌细胞行为。对于大麻，研究表明舌、喉以及可能还有肺癌的鳞状细胞癌风险增加。吗啡可能会刺激人微血管内皮细胞增殖和血管生成；目前尚不清楚这是否会造成损害或产生益处。阿片类药物芬太尼可能会促进某些肿瘤细胞系的生长。鸦片本身是胃腺癌以及可能的食管癌、膀胱癌、喉癌和肺癌的一个新出现的危险因素。结论是，目前用于癌痛的镇痛药会显著影响癌症进程本身。更具前瞻性的是，几种离子通道正成为新型镇痛药的作用靶点，但其中许多也与原发性和/或继发性肿瘤发生有关。需要进一步研究以阐明传统镇痛药可能的细胞和分子效应及其可能的长期影响，包括正面和负面的影响，从而为癌症患者实现最大可能的临床获益。
