Do circulating tumor cells play a role in coagulation and thrombosis?
- 1 Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- 2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- 3 Human Oncology and Pathogenesis Program, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
- 4 Department of Cell & Developmental Biology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
Cancer induces a hypercoagulable state, and patients with cancer who suffer a thrombotic event have a worse prognosis than those who do not. Recurrent pathologic thrombi in patients with cancer are clinically managed with anticoagulant medications; however, anticoagulant prophylaxis is not routinely prescribed owing to a complex variety of patient and diagnosis related factors. Early identification of patients at risk for cancer-associated thrombosis would allow for personalization of anticoagulant prophylaxis and likely reduce morbidity and mortality for many cancers. The environment in which a thrombosis develops in a patient with cancer is complex and unique from patients without cancer, which creates therapeutic challenges but may also provide targets for the development of clinical assays in this context. Circulating tumor cells (CTCs) may play a role in the association between cancer and thrombosis. Cancer metastasis, the leading cause of cancer-related deaths, is facilitated by the hematogenous spread of CTCs, and CTCs accompany metastatic disease across all major types of carcinomas. The role of CTCs in the pathogenesis of thrombosis has not been studied due to the previous difficulty in identifying these rare cells, but the interaction between these circulating cells and the coagulation system is an area of study that demands attention. The development of CTC detection platforms presents a new tool by which to characterize the role for CTCs in cancer-related hypercoagulability. In addition, this area of study presents a new avenue for assessing the risk of cancer-associated thrombosis and represents a potential tool for predicting which patients may benefit from anticoagulant prophylaxis. In this review, we will discuss the evidence in support of CTC induced hypercoagulability, and highlight areas where CTC-detection platforms may provide prognostic insight into the risk of developing thrombosis for patients with cancer.
Keywords: circulating tumor cells, thrombosis, tissue factor, metastasis, blood
Citation: Tormoen GW, Haley KM, Levine RL and McCarty OJT (2012) Do circulating tumor cells play a role in coagulation and thrombosis? Front. Oncol. 2:115. doi: 10.3389/fonc.2012.00115
Received: 01 June 2012; Accepted: 23 August 2012;
Published online: 10 September 2012.
Copyright: © 2012 Tormoen, Haley, Levine and McCarty. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.
*Correspondence: Garth W. Tormoen, Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, 3303 South West Bond Avenue, Portland, OR 97239, USA. e-mail: firstname.lastname@example.org