When Two Maladies Meet: Disease Burden and Pathophysiology of Stroke in Cancer

Abstract

Stroke and cancer are disabling diseases with an enormous global burden, disproportionately affecting vulnerable populations and low- and middle-income countries. Both these diseases share common risk factors, which warrant concerted attention toward reshaping population health approaches and the conducting of fundamental studies. In this article, an overview of epidemiological trends in the prevalence and burden of cancer and stroke, underlying biological mechanisms and clinical risk factors, and various tools available for risk prediction and prognosis are provided. Finally, future recommendations for research and existing gaps in our understanding of pathophysiology. Further research must investigate the causes that predispose patients to an increased risk of stroke and/or cancer, as well as biomarkers that can be used to predict growing morbidity and mortality.

Risk Factors and Prognosis of Stroke in Gynecologic Cancer Patients

“…In a large cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results program, patients with cancer were more than twice as likely to die of a stroke than the general population, and the risk increased with time. Additionally, cancers of the breast, prostate, or colorectum are most associated with fatal stroke [45,46]. As expected, in univariate analysis, stroke during treatment had an adverse effect on PFS.…”

“…Platinum compounds, which are most commonly used in gynecological cancers, seem to present a significant risk for stroke. Although the mechanisms involved remain largely unknown, platinum-associated thrombosis is theorized to be the result of direct endothelial damage and reduced anticoagulant factor synthesis [25,44,45]. Although cancer progression coupled with the acute emergence of stroke raises the suspicion of tumor emboli, it is almost impossible to differentiate whether stroke is a result of atherosclerotic or tumor-associated changes [6,25,44].…”

Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches

“…Cancer-related stroke or thromboembolism is a significant and potentially life-threatening complication that can affect individuals with cancer [1,2]. When compared to the general population, people with cancer have a significantly higher risk of stroke or thromboembolism [15,44].…”

“…Haematologic intracerebral haemorrhages should be distinguished from other aetiologies of haemorrhagic strokes as they may have varying prognoses and require different treatment approaches for optimal secondary prevention for recurrent cerebral vascular disease [62]. Concerning recommendations for future direction, the improvement and standardisation of screening tools are of utmost priority in bridging the gap between low-and middle-income countries (LMICs) around the globe [2,35]. In the therapeutic management of stroke in cancer patients, we provide a stratified toolkit for clinical decision making or management for treating clinicians, to inform their clinical decision making in determining the appropriate preventive therapy.…”

“…Cancer-related strokes have generated keen scientific and clinical interest [1,2]. They have a unique aetiopathophysiology distinct from noncancer-related strokes, warranting tailored/distinct treatment considerations [3].…”