Anesthetic Agents as Therapeutic Tools in Breast Cancer: Insights into Cancer Progression and Recurrence.

Abstract

Breast cancer (BC) remains one of the leading causes of cancer-related mortality worldwide, necessitating continuous advancements in therapeutic strategies. While anesthetic agents are traditionally used for managing pain and sedation during BC surgeries, emerging evidence suggests their potential influence on cancer progression and recurrence. This comprehensive review examines the role of various anesthetic agents as therapeutic tools in BC, exploring the molecular mechanisms underlying their interaction with tumor biology. The review categorizes anesthetics into volatile, intravenous, and local agents, discussing their differential effects on cancer cell proliferation, immune modulation, and metastatic potential. Key findings indicate that volatile anesthetics such as sevoflurane and isoflurane may promote tumor progression, whereas intravenous anesthetics like propofol exhibit anticancer properties. Local anesthetics, particularly lidocaine, and bupivacaine, show promise through voltage-gated sodium channel (VGSC) blockade, while opioids have mixed effects, with tramadol being less favorable in cancer settings. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac and diclofenac have demonstrated potential in reducing BC recurrence, and regional anesthesia techniques like paravertebral blocks may provide immunomodulatory benefits. Clinical studies assessing the correlation between anesthetic choice and BC recurrence suggest that perioperative anesthetic strategies may impact circulating tumor cells and postoperative metastasis. However, most findings are derived from preclinical and retrospective studies, highlighting the need for large-scale prospective trials. Future research should focus on tailoring anesthetic regimens to tumor biology and patient-specific factors, integrating anesthetic pharmacology into cancer care to improve both immediate surgical outcomes and long-term prognosis. This article underscores the need for a paradigm shift in anesthetic use, positioning it as a crucial player in BC treatment strategies.