Update on the role of circulating tumour cells in cancer-associated thrombosis

Abstract

Circulating Tumour Cells (CTCs), the mechanism by which cancer spreads from the primary tumour to distant metastatic sites and cancer-associated thrombosis (CAT), a systemic hypercoagulable state found in many cancer patients, appear to have a symbiotic relationship. CTCs initiate coagulation and may contribute to CAT, and conversely coagulation facilitates the intravasation of CTCs into the systemic circulation, survival in the circulation and extravasation at distant sites. CTCs may be a strong contributor to CAT through direct or indirect activation of coagulation. Whilst the potential for patient-specific CAT risk calculated by a combination of CTC count and blood coagulation factor concentrations has been suggested, evidence of a two-way relationship of hypercoagulability and increased CTC invasiveness is emerging. Tissue factor, the main activator of the extrinsic pathway of coagulation, is particularly implicated. Targeting the CTC-CAT axis is a promising target for improving patient outcome. This review provides background on CAT and CTCs along with recent developments in the field.

Keywords

• CTC
• CAT
• Metastasis
• Thrombosis
• Cancer
• Coagulation