Pelvic cancer pain

Pelvic cancer causes several types of pain, i.e., visceral, neuropathic, an d somatic pain. Somatic pain is due to stimulation of nociceptors in the in tegument and supporting structures, namely, striated muscles, joints, perio steum, bones, and nerve trunks by direct extension through fascial planes a nd their lymphatic supply. In 60% of patients with malignant disease of sof t tissues, nerve trunk, and sacral invasion from carcinoma of the cervix, u terus, vagina, colon, rectum, and other tissues in women, and from penile, prostate, and colorectal carcinoma and sarcoma in men, they have neuropathi c pain. The infiltration of the perineal nerves results in lumbosacral plex opathies and complete destruction of the nerve, including perineural lympha tic invasions producing symptomatic sensory loss, causalgia, and deafferent ation. Visceral pain is the result of spasms of smooth muscles of hallow vi scus; distortion of capsule of solid organs; inflammation; chemical irritat ion; traction or twisting of mesentery; and ischemia, or necrosis, and encr oachment of pelvis and presacral tumors. Pain of these types is managed by different modalities depending on the age of the patient, the expected life expectancy, availability of invasive and noninvasive pain control modaliti es, and the resources of the patient, community, and health care agencies. Patients with pelvic cancer can live with less pain due to better pain-cont rol modalities that are available today with the help of dedicated and cari ng algologists. (C) 2000 Wiley-Liss, Inc.