Book Review

Thrombosis and Cancer

N Engl J Med 2005; 352:2459June 9, 2005

Article

Thrombosis and Cancer
Edited by Gilles Lugassy, Anna Falanga, Ajay K. Kakkar, and Frederick R. Rickles. 230 pp. London, Martin Dunitz, 2004. $125. ISBN: 1-84184-287-7

The association between thrombosis and cancer represents a challenge to scientists and physicians of various disciplines. From a clinician's point of view, progress in this field during the past several years has been substantial. In a patient presenting with venous thrombosis who is otherwise healthy, for example, the likelihood that there is a hidden cancer is now well defined, and we have estimates of the risk of thrombosis among patients with cancer who are exposed to surgery, chemotherapy, or the insertion of a central venous catheter. With the development of new antithrombotic drugs, particularly the low-molecular-weight heparins, preventive and therapeutic strategies are now available, and they are effective, safe, and less inconvenient for the patients than were previous forms of treatment.

The contributors to this book are leading scientists in the field, and some of them conducted the studies under discussion. Hence, the information given is largely firsthand. Eight of the 16 chapters are dedicated to the clinical side of cancer-associated thromboembolism and give detailed, state-of-the-art overviews of epidemiology, risk assessment, prevention, and treatment. In addition to the clear and extensive coverage of current preventive and therapeutic concepts for cancer-related thromboembolism, controversial issues are dealt with comprehensively. For instance, Piccioli and Prandoni address the still-open question of whether or not to screen patients with deep-vein thrombosis for the presence of a hidden cancer, and the treatment of patients with cancer in whom a central venous catheter has been inserted is discussed by several authors. As with many such books, some of the content is dated. For example, long-term anticoagulation therapy with a vitamin K antagonist is no longer the preferred treatment in patients with cancer, since low-molecular-weight heparin has turned out to be more effective than and at least as safe as warfarin.

The mechanisms by which cancer cells promote the activation of coagulation are complex and not entirely understood, and the function of the hemostatic system with respect to tumor growth, angiogenesis, and metastasis is even more obscure. Considering that the book was written for all physicians involved in the treatment of patients with cancer, including general practitioners and internists, one has to admire the editors' courage to devote more than one third of the content to basic science. An excellent overview of the mechanisms of thrombosis in patients with cancer, by Falanga, Marchetti, and Vignoli, is followed by three chapters summarizing the mechanisms of tumor-platelet interactions and the role of both the clotting cascade and the fibrinolytic system in the pathogenesis of neoplasia and tumor metastasis. The basic-science part culminates in a chapter entitled “Tumor Angiogenesis and Blood Coagulation,” by Fernandez, Patierno, and Rickles. It is well illustrated and dissects the coagulation cascade, from tissue-factor activation through fibrin deposition, thereby summarizing the ways in which key components of the cascade directly or indirectly contribute to tumor angiogenesis. This chapter is the highlight of this interesting book.

Thrombosis and Cancer is a well-written multiauthored book that, to a large extent, will fulfill its stated purpose — “to provide comprehensive and timely coverage of our current knowledge of cancer-associated thrombosis.” It will be of interest to clinicians in many disciplines.

Paul Kyrle, M.D.
Medical University of Vienna, 1090 Vienna, Austria
paul.kyrle@meduniwien.ac.at