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Chapter 16. Local Anesthetics, Regional Anesthesia, and Cancer Recurrence

Which of the following statements is true regarding the perioperative period and immune modulation?

A. Hypotension and hypovolemia at the time of surgery may influence the immune balance of cancer patients in a deleterious fashion predisposing to cancer cell metastasis.

B. Hypotension and hypovolemia may influence immune modulation by increasing the Th1 (T helper 1) response.

C. Th2-type immune responses are necessary for antitumor immunity.

D. NK cells have a crucial role in the propagation of metastases in the perioperative period.

A is correct. Hypotension and hypovolemia at the time of surgery may influence the immune balance of cancer patients in a deleterious fashion predisposing to cancer cell metastasis.

B is incorrect. Hypotension and hypovolemia may influence immune modulation in the perioperative period by suppressing the Th1 response, thereby shifting the balance in favor of Th2.

C is incorrect. Th1 response is the immune response necessary for antitumor immunity.

D is incorrect. NK cells have a crucial role in antitumor immunity.

Which of the following statements is true regarding the Th1 to Th2 ratio and role in the development of cancer metastasis?

A. The natural killer (NK), CD4+ Th1 (T helper 1), and CD8+ CTL (cytotoxic lymphocyte) cells are the most important cells in the promotion of tumor growth and metastasis.

B. Th2 (T helper 2), tumor-associated macrophages (TAM), and regulatory T (Treg) cells are among the major antitumor immune effector cells.

C. NK cells have a crucial role, particularly in eliminating metastases without prior sensitization and major histocompatibility complex (MHC) restriction.

D. NK cell function can be upregulated by prostaglandins, especially prostaglandin E2 (PGE2), shifting the cytokine balance toward Th2 dominance and promoting tumor angiogenesis.

E. Proinflammatory cytokines (IL-6, tumor necrosis factor alpha [TNF-α], IL-13) released from infiltrating leukocytes close to the primary tumor site can activate nuclear factor κB (NF-κB) and STAT3 in cancer cells and thus inhibit tumor growth and proliferation.

C is correct. NK cells have a crucial role, particularly in eliminating metastases without prior sensitization and major histocompatibility complex (MHC) restriction.

A is incorrect. The natural killer (NK), CD4+ Th1 (T helper 1), and CD8+ CTL (cytotoxic lymphocyte) cells are the major antitumor immune effector cells.

B is incorrect. Th2 (T helper 2), tumor-associated macrophages (TAM), and regulatory T (Treg) cells are among the most important ...

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