Stroke and Cancer- A Complicated Relationship

Overview

Journal J Neurol Transl Neurosci

Date 2015 Sep 1

PMID 26322334

Citations 62

Authors

Jennifer L Dearborn

Victor C Urrutia

Steven R Zeiler

Affiliations

Soon will be listed here.

Abstract

The interrelationship between stroke and cancer is complex. Cancer and stroke may occur independently in a given patient, or cancer may directly or indirectly lead to stroke via: hypercoaguability, non-bacterial thrombotic endocarditis (NBTE), direct tumor compression of blood vessels, or treatment-related effects which potentiate stroke. Patients with cryptogenic stroke are relatively common, and under the right circumstances, may provide an opportunity to screen for occult malignancy. In this review, we discuss relevant data linking stroke and cancer as well as propose a testable algorithm for cancer screening in the patient with cryptogenic stroke. Future directions should focus on validating patient-care algorithms in prospective clinical trials to provide an evidence base for this important issue.

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References

Kase C . Intracerebral hemorrhage: non-hypertensive causes. Stroke. 1986; 17(4):590-5. DOI: 10.1161/01.str.17.4.590. View

Kwon H, Kang B, Yoon B . Stroke as the first manifestation of concealed cancer. J Neurol Sci. 2007; 258(1-2):80-3. DOI: 10.1016/j.jns.2007.02.035. View

Sturgeon C, Duffy M, Hofmann B, Lamerz R, Fritsche H, Gaarenstroom K . National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in liver, bladder, cervical, and gastric cancers. Clin Chem. 2010; 56(6):e1-48. DOI: 10.1373/clinchem.2009.133124. View

Agnelli G, Gussoni G, Bianchini C, Verso M, Mandala M, Cavanna L . Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study. Lancet Oncol. 2009; 10(10):943-9. DOI: 10.1016/S1470-2045(09)70232-3. View

Carmody B, Arora S, Avena R, Curry K, Simpkins J, Cosby K . Accelerated carotid artery disease after high-dose head and neck radiotherapy: is there a role for routine carotid duplex surveillance?. J Vasc Surg. 1999; 30(6):1045-51. DOI: 10.1016/s0741-5214(99)70042-x. View

Caine G, Stonelake P, Lip G, Kehoe S . The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia. 2002; 4(6):465-73. PMC: 1550339. DOI: 10.1038/sj.neo.7900263. View

de Jong G, Kessels F, Lodder J . Two types of lacunar infarcts: further arguments from a study on prognosis. Stroke. 2002; 33(8):2072-6. DOI: 10.1161/01.str.0000022807.06923.a3. View

Sacco R, Ellenberg J, Mohr J, Tatemichi T, Hier D, Price T . Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol. 1989; 25(4):382-90. DOI: 10.1002/ana.410250410. View

Hong C, Tsai L, Jeng J . Patterns of acute cerebral infarcts in patients with active malignancy using diffusion-weighted imaging. Cerebrovasc Dis. 2009; 28(4):411-6. DOI: 10.1159/000235629. View

10.

Hurwitz H, Saltz L, Van Cutsem E, Cassidy J, Wiedemann J, Sirzen F . Venous thromboembolic events with chemotherapy plus bevacizumab: a pooled analysis of patients in randomized phase II and III studies. J Clin Oncol. 2011; 29(13):1757-64. DOI: 10.1200/JCO.2010.32.3220. View

11.

Obeid M, Ulane C, Rosenfeld S . Pearls & Oy-sters: Large vessel ischemic stroke secondary to glioblastoma multiforme. Neurology. 2010; 74(13):e50-1. DOI: 10.1212/WNL.0b013e3181d7d66a. View

12.

Pantoni L . Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010; 9(7):689-701. DOI: 10.1016/S1474-4422(10)70104-6. View

13.

Kakkar A, Levine M, Kadziola Z, Lemoine N, Low V, Patel H . Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the fragmin advanced malignancy outcome study (FAMOUS). J Clin Oncol. 2004; 22(10):1944-8. DOI: 10.1200/JCO.2004.10.002. View

14.

Stewart F, Heeneman S, Te Poele J, Kruse J, Russell N, Gijbels M . Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/- mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage. Am J Pathol. 2006; 168(2):649-58. PMC: 1606487. DOI: 10.2353/ajpath.2006.050409. View

15.

Schwarzbach C, Schaefer A, Ebert A, Held V, Bolognese M, Kablau M . Stroke and cancer: the importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke. 2012; 43(11):3029-34. DOI: 10.1161/STROKEAHA.112.658625. View

16.

Altinbas M, Coskun H, Er O, Ozkan M, Eser B, Unal A . A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer. J Thromb Haemost. 2004; 2(8):1266-71. DOI: 10.1111/j.1538-7836.2004.00871.x. View

17.

Agnelli G, George D, Kakkar A, Fisher W, Lassen M, Mismetti P . Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med. 2012; 366(7):601-9. DOI: 10.1056/NEJMoa1108898. View

18.

Eliasson A, Bergqvist D, Bjorck M, Acosta S, Sternby N, Ogren M . Incidence and risk of venous thromboembolism in patients with verified arterial thrombosis: a population study based on 23,796 consecutive autopsies. J Thromb Haemost. 2006; 4(9):1897-902. DOI: 10.1111/j.1538-7836.2006.02152.x. View

19.

Kolominsky-Rabas P, Weber M, Gefeller O, Neundoerfer B, Heuschmann P . Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001; 32(12):2735-40. DOI: 10.1161/hs1201.100209. View

20.

Foreman N, Mahmoud H, Rivera G, Crist W . Recurrent cerebrovascular accident with L-asparaginase rechallenge. Med Pediatr Oncol. 1992; 20(6):532-4. DOI: 10.1002/mpo.2950200608. View