Tumour angiogenesis: the relevance to surgeons

Abstract

Introduction: Angiogenesis is the process of new blood vessel formation from pre-existing vessels, and is a key feature of malignant tumours. Surgeons involved in the management of patients with malignant disease need to be aware of angiogenic mechanisms and their surgical implications.

Patients and methods: A literature search was used to review recent developments in our understanding of the factors and processes involved in tumour angiogenesis, and how these will impact on the care of patients with malignant disease encountered by surgeons.

Results: Angiogenesis is fundamental to all stages of the malignant process, and involves a complex interaction between mediators secreted by tumour cells and host cells. Intense investigation continues into therapies targeting components of the angiogenic cascade. Imaging modalities capable of measuring the angiogenic activity of a tumour are also being studied in order to predict prognosis and select suitable patients for anti-angiogenic therapy.

Conclusions: As the use of these anti-angiogenic therapies becomes more wide-spread, they may have implications on the healing rates of cutaneous wounds and intracorporeal anastomoses.

Figure 1

The stages of neovascularisation (BM, basement membrane).

Figure 2

Histological rectal carcinoma section showing blood vessels stained by the endothelial marker CD31 (diaminobenzidine labelled, ×100).

Figure 3

(A) T1-weighted magnetic resonance image of a rectal carcinoma (white arrow). (B) Corresponding map of transfer constant (K^trans), a marker of capillary permeability (white areas represent high capillary permeability).