Acquired Hypercoagulability and Widespread Bleeding in Advanced Cancer Patients
Two common problems affect the circulatory system of advanced cancer patients: one is an acquired hypercoagulable state, and the other is widespread bleeding. These two problems make the medical management of advanced cancer patients very difficult: one must both prevent cancer emboli caused by clotting and guard against widespread bleeding; a single careless step can be fatal. If both concerns are addressed, the patient's life can be prolonged and quality of life improved.
The reason advanced cancer patients develop these two seemingly contradictory problems is that cancer cells can release procoagulant factors, such as tissue factor, leading to multiple, recurrent, migratory thrombophlebitis or nonbacterial thrombotic endocarditis. The cancer cells of mucinous carcinomas also secrete mucus containing cysteine protease, which can directly activate factor X; plasma levels of various coagulation factors and fibrinogen are also often elevated, so the blood is frequently in a hypercoagulable state.
The release of large amounts of procoagulant material into the blood triggers extrinsic coagulation. The massive consumption of coagulation factors exhausts the body's clotting system. In addition, after fibrin forms, it promotes plasminogen activation, and the blood then develops a coagulation disorder. This causes widespread bleeding throughout the body, even shock; modern medicine calls this consumptive coagulopathy. If bleeding occurs in critical organs such as the heart or brain, it can even directly cause the patient's death.
Understanding this pathological mechanism helps us design a more prudent treatment strategy for advanced cancer patients. We must take into account both the patient's tendency toward a hypercoagulable state and the risk of widespread systemic bleeding. In TCM treatment of advanced cancer patients, blood-activating herbs and hemostatic herbs are often used together; this seems contradictory, yet it is precisely a relatively prudent solution to this contradictory feature of the circulatory system in advanced cancer.
These problems occur most often in patients with pancreatic, lung, breast, prostate, and gastric cancer, so when treating these cancers we need to pay special attention to this point.