Figure 4
From: Promising development from translational or perhaps anti-translational research in breast cancer
Symbolic description of proposed mechanical and biological explanations for Forget et al. data. Early relapses are assumed to be related, at least in part, to the inflammatory process due to primary tumor surgical removal, directly or indirectly eliciting peritumoral endothelial cell proliferation according to the biological mechanisms. A) Angiogenic factors, like VEGF and bFGF, are directly released or even produced via IL-6; B) Bone marrow derived CXCR-4 positive cells, acting both on tumor foci and on the inflammatory process, are mobilized by SDF-1, directly released or even produced via COX-2. Perioperative Ketorolac would restrict both endocrine and cellular pathways, thus impairing the metastatic process. CTC refers to circulating tumor cells. Also shown is how a mechanical explanation prevents these early relapses. Capillary leakage from transient systemic inflammation as a result of the surgery in the presence of circulating cancer cells and cells released during surgery and resulting inflammatory oncotaxis is blocked by directly preventing the inflammation. This prevents single cell activation. In addition, NSAIDS have antiangiogenic properties thus surgery-induced angiogenesis is prevented.