Hemostasis and malignancy

There is considerable evidence that the hemostatic system is involved in th e growth and spread of malignant disease. There is an increased incidence o f thromboembolic disease in patients with cancers and hemostatic abnormalit ies are extremely common in such patients. Antihemostatic agents have been successfully used to treat a variety of experimental tumors, and several cl inical trials in humans have been initiated. Although metastasis is undoubt edly multifactorial, intravascular coagulation activation and peritumor fib rin deposition seem to be important. The mechanisms by which hemostatic act ivation facilitates the malignant process remain to be completely elucidate d. Of central importance may be the presence on malignant cells of tissue f actor and urokinase receptor. Recent studies have suggested that these prot eins, and others, may be involved at several stages of metastasis, includin g the key event of neovascularization, Tissue factor, the principal initiat or of coagulation, may have additional roles, outside of fibrin formation, that are central to the biology of some solid tumors.