aSarcoma Unit bDepartment of Radiotherapy and Physics, Royal Marsden Hospital, London cInstitute of Cancer Research, Sutton dProtein Phosphorylation Laboratory, CRUK London Research Institute, London, UK.
Curr Opin Support Palliat Care. 2014 Jun;8(2):102-11. doi: 10.1097/SPC.0000000000000043.
Pain is the most common symptom in patients with advanced cancer and often persists despite treatment. Recent advances in oncological therapy and the molecular basis of cancer and pain will help to improve patient outcomes.
Chemotherapy, targeted therapy and radiotherapy are important components of the multidisciplinary management of cancer pain, which also includes early referral to specialist pain services. Cancer pain is complex and an understanding of the type of pain, the biology of the particular cancer as well as patient factors must be considered. Conventional palliative radiotherapy provides effective pain relief from cancer metastases, and recently radiopharmaceuticals have been shown to be beneficial for bone metastasis. Systemic cancer therapy can provide pain relief as a result of tumour shrinkage but recent studies suggest that benefit may also be as a consequence of modulation of pain signalling pathways.
In advanced cancers, oncological therapies must be considered as anti-pain treatments. Identifying molecular targets that have a role in both pain and cancer is an interesting strategy for future drug development.
疼痛是晚期癌症患者最常见的症状，尽管经过治疗，疼痛仍常常持续存在。肿瘤治疗的最新进展以及癌症和疼痛的分子基础将有助于改善患者的预后。
化疗、靶向治疗和放疗是癌症疼痛多学科管理的重要组成部分，其中还包括及早向疼痛专科转介。癌症疼痛是复杂的，必须了解疼痛的类型、特定癌症的生物学特性以及患者的因素。常规姑息性放疗可有效缓解癌症转移引起的疼痛，最近放射药物已被证明对骨转移有益。全身癌症治疗可因肿瘤缩小而缓解疼痛，但最近的研究表明，其疗效也可能是由于疼痛信号通路的调节。
在晚期癌症中，肿瘤治疗必须被视为止痛治疗。确定在疼痛和癌症中都起作用的分子靶点是未来药物开发的一个有趣策略。
