Abstract
Cancer incidence is increasing worldwide, partially due to the population ageing. This can be linked to advanced and accessible medical care. This trend represents a challenge for healthcare systems in many countries. Development of new diagnostic procedures and therapeutic approaches seems to be necessary for sensible care for therapeutically fragile elderly patients. The cancer microenvironment, especially cancer-associated fibroblasts, represents a promising target for therapeutic manipulation, which has not yet been fully exploited.
The chapter summarises data about the origin, markers and biological properties of cancer-associated fibroblasts. The position of cancer-associated fibroblasts in the tumour cellular ecosystem has been established, and their influence on cancer cell proliferation, differentiation, migration and therapeutic resistance is widely recognised.
Cancer-associated fibroblasts can potentially result from transition from a broad panel of cell types. The most relevant mechanism seems to be recruitment of normal tissue fibroblasts and mesenchymal stem cells. This is achieved by means of paracrine secretion from cancer cells or via secreted exosomes. CAFs are heterogeneous and represent a potent source of growth factors, pro-inflammatory cytokines, chemokines and also exosomes that significantly activate proliferation and migration of cancer cells.
Cancer-associated fibroblasts represent a biologically potent and non-malignant population of cells in malignant tumours. CAF detection and phenotypic and functional characterisation in the distinct types of tumours can refine diagnostics. Moreover, CAFs are an available target for therapeutic interventions, which can potentially advance oncological therapy.