The role of mechanical forces in tumor growth and therapy

• Published in: Annual review of biomedical engineering Vol. 16; p. 321
• Main Authors: Jain, Rakesh K, Martin, John D, Stylianopoulos, Triantafyllos
• Format: Journal Article
• Language: English
• Published: United States 11.07.2014
• Subjects: Animals; Disease Progression; Drug Delivery Systems; Extracellular Fluid; Humans; Hypoxia; Immune System; Lymph; Microcirculation; Models, Theoretical; Neoplasm Metastasis; Neoplasms - pathology; Neoplasms - physiopathology; Neoplasms - therapy; Perfusion; Shear Strength; Stress, Mechanical; Vascular Endothelial Growth Factor A - chemistry; vascular normalization; tumor perfusion; stress alleviation; vascular hyperpermeability; tumor microenvironment; vessel compression; solid stress
• ISSN: 1545-4274
• DOI: 10.1146/annurev-bioeng-071813-105259

Tumors generate physical forces during growth and progression. These physical forces are able to compress blood and lymphatic vessels, reducing perfusion rates and creating hypoxia. When exerted directly on cancer cells, they can increase cells' invasive and metastatic potential. Tumor vessels-while nourishing the tumor-are usually leaky and tortuous, which further decreases perfusion. Hypoperfusion and hypoxia contribute to immune evasion, promote malignant progression and metastasis, and reduce the efficacy of a number of therapies, including radiation. In parallel, vessel leakiness together with vessel compression causes a uniformly elevated interstitial fluid pressure that hinders delivery of blood-borne therapeutic agents, lowering the efficacy of chemo- and nanotherapies. In addition, shear stresses exerted by flowing blood and interstitial fluid modulate the behavior of cancer and a variety of host cells. Taming these physical forces can improve therapeutic outcomes in many cancers.