Is Cancer a Terrorist of Pain?

Cancer cells hijack the human immune system and nervous system to gain a growth advantage.

Patients are getting better treatments, so they are now living longer with their disease. As a result, they are developing a unique type of chronic pain with the cancer cell participating in the pain.

Managing pain is the greatest challenge in cancer particularly for those types with no cure. Treating cancer pain has not kept in step with cancer treatment and a gap exists between what is going on in the lab and in the clinic.

In cancer, one of our cells will break off and reproduce itself at the expense of the organism. It hijacks the nervous system to grow faster. In the past, we viewed cancer pain as simply a result of the cancer growing and taking energy and metabolites from the surrounding structure, and as it gets bigger compressing the nerve and causing activation.

Elucidating the mechanisms of pain in different type of cancers will help treat the pain. In particular, studying oral cancer pain is a good model, as it is painful and pain is the most common presenting symptom.

In oral cancer, the pain is at the primary site and the mouth is an accessible location. Similar mechanims trigger pain in other cancers – functions such as eating and talking initiate pain associated with oral cancer.

Pain in the mouth is an initial presenting sign for oral cancer; it is different for other cancers – eg breast cancer and prostate cancer – where the primary site does not necessarily present first with pain.

Cancer cells secrete immunomodulators that increase local inflammation and nerve growth factor that stimulates nerve cell growth. They also secrete proteases that destroy surrounding tissues and spread. Protease activated receptors help mediate the cancer pain.

In some types of cancer, there is no pain associated with dysplasia but there is pain associated with malignancy. So there is some factor associated with the transformation to malignancy that causes the pain.




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