Fig. 6

Mechanisms by which cardiac scarring and remodelling may promote a pro-oncogenic environment (Cardio-Oncology Syndrome Type III). This schematic demonstrates how a pro-oncogenic environment can result from cardiac dysfunction. With cardiac dysfunction (i.e. development of heart failure after a myocardial infarction), increased central venous congestion can result in hypoperfusion for various end organs, which then release stress signals that may increase tumour growth, angiogenesis, and tumour invasiveness. Increased filling pressures may similarly result in pulmonary congestion and the increase in stress signals. Cardiac dysfunction may also result in release of cardiokines, increased oxidative stress, and pro-inflammatory factors which may result in stimulated tumour growth, angiogenesis, and tumour invasiveness