Unit:
Κατεύθυνση Κλινικοπαθολογοανατομική θεώρηση των νεοπλασιών του ανθρώπουLibrary of the School of Health Sciences
Author:
Baxevanos Panagiotis
Supervisors info:
Ανδρέας X. Λάζαρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Θυμαρά Ειρήνη, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Τσαβαρής Νικόλαος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Διαταραχές Πήξης στον Καρκίνο του Προστάτη
Translated title:
Coagulation Disorders in Prostate Cancer
Summary:
Prostate cancer (PC) is the second most common cancer in men worldwide. Across the entire spectrum of disease, coagulation disorders are likely to occur and contribute to increased morbidity and mortality. The disrupting effect of many cancers on the normal coagulation and hemostatic pathways facilitates tumor growth and dissemination. Basic clotting factors such as tissue factor, thrombin, fibrin and platelets have a crucial role in this interplay, by promoting the complex processes of angiogenesis and metastasis. Specifically in PC, multiple preclinical and clinical studies have shown its association with the enhancement of both coagulation and fibrinolytic activity as well as the activation of platelets. Thus, these conditions lead to the occurrence of both thrombotic and bleeding disorders.
The most characteristic coagulation disorder in PC is Disseminated Intravascular Coagulation (DIC). Frequently this disorder presents initially as a chronic and subclinical state in which coagulation and fibrinolysis are activated in a balanced way, while it suddenly progresses to an acute decompensated DIC with enhanced fibrinolysis and severe bleeding manifestations.
Early diagnosis with prompt symptomatic and antineoplastic treatment are needed for the successful management of this potentially fatal disorder.
Venous Thromboembolic Disease (VTD) is also frequently described in patients with PC. Besides the thrombogenic potential of cancer, the etiopathogenesis of VTD in PC includes individual risk factors and the impact of cancer treatments. Radical prostatectomy and hormone therapy, mainly estrogens, are associated with increased risk of VTD. Low molecular weight heparins are the drug of choice in both treatment and prevention of VTD.
Very rare coagulation disorders that have been reported in patients with PC are thrombotic microangiopathy with features of hemolytic uremic syndrome and acquired hemophilia A, and far fewer are the cases of pulmonary tumor thrombotic microangiopathy, Henoch-Schonlein purpura and immune thrombocytopenia. Involvement of the immune system is critical for the pathogenesis of most of these rare disorders. Plasmapheresis in thrombotic microangiopathy and immunosuppressive medications in acquired hemophilia A were effective measures according to the few reports.
Main subject category:
Health Sciences
Keywords:
Prostate cancer, Coagulation disorders, Disseminated Intravascular Coagulation, Venous Thromboembolic Disease
Number of references:
165
Number of pages:
94 σελίδες
File:
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ΔΙΠΛΩΜΑΤΙΚΗ.pdf
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