Cliona Kirwan investigates the relationship between clotting and cancer.

NIHR Clinician Scientist in Surgical Oncology

University Hospital of South Manchester
Southmoor Road
Manchester
M23 9LT

I graduated in Medicine from Charing Cross and Westminster Medical School. Alongside my medical degree, I studied for a BSc in the History of Medicine at University College London.

I carried out doctoral studies at The University of Manchester – my project was entitled “The Role of Procoagulants in Cancer and Chemotherapy Induced Venous Thromboembolism”.

I am a NIHR Clinician Scientist in Surgical Oncology and Consultant Oncoplastic Breast Surgeon. My work is split equally between clinical work and academia. Clinically, I lead diagnostic and follow up clinics for breast disease, particularly breast cancer. I perform all forms of surgery for the treatment of breast disease, particularly breast cancer surgery including breast reconstruction, symmeterisation operations and oncoplastic remodelling to minimise the cosmetic impact of breast surgery.

I train medical students, allied staff and trainee surgeons and I am a lecturer for The University of Manchester medical undergraduate course and the ASiT (Association of Surgeons in Training) MRCS (Membership of the Royal College of Surgeons) course. Academically, as a Senior Lecturer, I lead a team investigating the symbiotic relationship between cancer and the clotting system. I specialise in translational research and run clinical and laboratory-based studies, and supervise PhD, MD and MRes students. In addition, my management roles include membership of the NCRI Early Disease Subgroup of the Breast Cancer Studies Group, Trials Management Group for the IMPORT Low and High and POETIC national randomised controlled trials, The University of Manchester Womens’ Cancer Centre Principal Investigators Board, Manchester Breast Centre Principal Investigators Board and the Genesis Breast Cancer Prevention Medical Advisory Board. I am also mentor to the Northwest Research Collaborative (a trainee led collaborative) and the Northwest and Mersey Breast Trainees Research Collaborative.

Patient-derived Mammosphere and Xenograft Tumour Initiation Correlates with Progression to Metastasis.

Eyre, R., Alférez, D. G., Spence, K., Kamal, M., Shaw, F. L., Simões, B. M., Santiago-Gómez, A., Sarmiento-Castro, A., Bramley, M., Absar, M., Saad, Z., Chatterjee, S., Kirwan, C., Gandhi, A., Armstrong, A. C., Wardley, A. M., O'Brien, C. S., Farnie, G., Howell, S. J. & Clarke, R. B.

Journal of Mammary Gland Biology and Neoplasia.  28 Sep 2016.

Tissue Factor promotes breast cancer stem cell activity in vitro

Shaker, H., Harrison, H., Clarke, R., Landberg, G., Bundred, N., Versteeg, H. & Kirwan, C.

Oncotarget. 2016.

Improving accuracy of clinical coding in surgery: collaboration is key

Heywood, N. A., Gill, M., Charlwood, . N., Brindle,  R. & Kirwan, C.

Journal of Surgical Research. 2016. 204(2), 490–495

It’s PRIMETIME. Postoperative Avoidance of Radiotherapy: Biomarker Selection of Women at Very Low Risk of Local Recurrence

Kirwan, C. & Coles, C. E.

Clinical Oncology. 2016. 28(9):594-6

Reply to: Letter Infection prevention in breast implant surgery e A review of the surgical evidence, guidelines and a checklist

Topps, A. R., Barr, S., Barnes, N. L. P. & Kirwan, C.

European Journal of Surgical Oncology. 2016. 42(8), 1248

Increased peri-ductal collagen micro-organization may contribute to raised mammographic density.

Mcconnell, J., O'Connell, O. V., Brennan, K., Weiping, L., Howe, M., Joseph, L.,  Knight, D., O'Cualain, R., Lim, Y., Leek, A. , Waddington, R., Rogan, J., Astley, S. M., Gandhi, A., Kirwan, C. C., Sherratt, M.J., Streuli, C.

Breast Cancer Research. 2016. 18, (5).

Locally Advanced Breast Cancer: Autologous and implant-based immediate reconstruction of locally advanced breast cancer: A comparative study.

Peregudova, E. P., Chow, W., Angelaki, A., Kirwan, C. C., Hamed, H. & Farhadi, J.

Plastic and Reconstructive Surgery. 2015. 4(2): e622

Clinical and radiological presentation of pleomorphic lobular carcinoma in-situ and its association with invasive malignancy.

Jain Y, Morris K, Miles H, Kirwan CC, Harvey JR.

Cancer Treatment Communications. 2015. 4:113-116

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using linked UK healthcare data.

Walker, A. J., West, J., Card, T. R., Crooks, C. R., Kirwan, C. C. & Grainge, M.

Blood. 2015. 127(7):849-57.

The use of isotope injections in sentinel node biopsy for breast cancer: a comparison of the one day and two day protocols.

Dodia, N., El-Sharief, D. & Kirwan, C. C.

SpringerPlus. 2015. 4: 495.

Breast Surgery.

C C Kirwa

Oxford Handbook of Key Clinical Evidence. Oxford: Oxford University Press. Ch20. (2014)

The significance of circulating tumour cells in breast cancer: A review.

Castle J, Shaker H, Morris K, Tugwood J, Kirwan CC

Breast. 2014 Oct;23(5):552-560.

Tumour bed clip localisation for targeted breast radiotherapy: compliance is proportional to trial-related research activity.

C C Kirwan, W Al Sarakbi, J Loncaster, HY Chan, AM Thompson, G C Wishart.

European Journal of Surgical Oncology 2014 Feb;40(2):158-62.

Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. 

Eccles SA et al.

Breast Cancer Res. 2013 Oct 1;15(5):R92

Immediate breast reconstruction does not increase post-mastectomy pain.

J Henderson, A Tao, CC Kirwan, L Barr.

Annals of Surgical Oncology 2014 Jan;21(1):113-7

Letter to the Editor regarding manuscript entitled: Completion axillary dissection can safely be omitted in screen detected breast cancer patients with micrometastases. A decade's experience from a single institution.

CC Kirwan, D Debnath, MC Howe, RK Johnson, NJ Bundred.

EJSO 2013 Nov;39(11):1294-5.

Breast cancer screening: what does the future hold?

C C Kirwan

British Medical Journal, 2013 Jan 23; 346:f87.

National Survey of Breast Cancer Specimen Orientation Marking Systems

AJ Volleamere, CC Kirwan

European Journal of Surgical Oncology, 2013 Mar; 39(3):255-9.

Minerva: Axillary extra-mammary Paget disease.

E Philips, CC Kirwan, S Melmore, LS Chagla.

British Medical Journal, 2012 Feb 25;344:52

Orbital metastases as the primary presentation of lobular breast cancer

A Volleameare, CC Kirwan, M Bramley.

Breast Journal, 2013 May; 19(3):333-4

Incidence of Venous Thromboembolism during Chemotherapy for Breast Cancer: Impact on Cancer Outcome.

CC Kirwan, G McDowell, CN McCollum, GJ Byrne.

Anticancer Research, 2011; 31:3-8

Our main focus of research is the symbiotic relationship between cancer and clotting. It is well recognised that cancer patients are at increased risk of deep vein thrombosis and pulmonary embolism and cancer seems to promote clotting. Cancer patients, especially those with more advanced disease, have increased levels of clotting molecules in their blood. However it is now known that this is a two-way process. The clotting system is also helping cancer grow and spread. We are exploring ways to treat cancer through targeting the clotting system.

Our prospective cohort study, entitled “The Role of Procoagulants in Cancer and Chemotherapy Induced Venous Thromboembolism” investigated patients receiving chemotherapy for advanced and early breast cancer. We explored alterations in circulating levels of procoagulant molecules expressed by cancer cells (tissue factor; tumour necrosis factor; vascular endothelial growth factor by ELISA, thrombospondin by radio-immunoassay and cancer procoagulant by an indirect chromogenic assay). This was compared to markers of angiogenesis (VCAM), hypercoagulability (D-dimer, thrombin-antithrombin, prothrombin fragments 1+2, plasminogen activator inhibitor), development of venous thromboembolism, response to treatment and death.

This research was followed by the CHAMPion (Cancer-induced Hypercoagulability as A Marker of Prognosis) Study, a 540-patient multicentre study, adopted by the NCRN (database number 8685), investigating clotting in early breast and colorectal cancer patients. We also lead on ‘Post-radiotherapy Perfusion’, a cohort study assessing the role of near-infrared spectroscopy in assessing long-term breast radiotherapy damage and collaborate on the Northwest Research Collaborative PPAC (Packing of Perianal Abscess Cavities) feasibility study and planned RCT study.

As part of an NIHR Clinician Scientist Award, entitled ‘The Thrombin Pathway in Breast Cancer Dissemination: a potential biomarker and novel therapeutic target’, we lead the T-POETIC multicentre study (UKCRN database number 12314), the TuFCLot study (investigating circulating tumour cells in breast cancer), and the TIP Trial. In addition we have laboratory studies exploring the role of clotting on cancer stem cells and the tumour microenvironment.

CC Kirwan, GJ Byrne, S Kumar, G McDowell.

Platelet release of Vascular Endothelial Growth Factor (VEGF) in patients undergoing chemotherapy for breast cancer.

Journal of Angiogenesis Research, 2009 Oct 24;1:7.

CC Kirwan, G McDowell, CN McCollum, S Kumar, GJ Byrne.

Early changes in the procoagulant and haemostatic systems after chemotherapy for breast cancer.

British Journal of Cancer, 2008; 99(7): 1000-6.

GJ Byrne, KE Hayden, G McDowell, H Lang, CC Kirwan, L Tetlow, S Kumar, NJ Bundred. Angiogenic characteristics of circulating and tumoural thrombospondin-1 in breast cancer.

International Journal of Oncology, 2007; 31(5): 1127-32.

A Al-Mowallad, CC Kirwan, GJ Byrne, G Mc Dowell, C Li, A Stewart, S Kumar.

Vascular endothelial growth factor-C in patients with breast cancer.

In Vivo, 2007; 21(3): 549-51.

S Patiar, CC Kirwan, G McDowell, NJ Bundred, CN McCollum, GJ Byrne.

Prevention of venous thromboembolism in surgical patients with breast cancer.

British Journal of Surgery, 2007; 94(4): 412-420.

CC Kirwan, CN McCollum, NJ Bundred, GJ Byrne.

Current UK practice of thromboprophylaxis for breast surgery. BJS, 2006; 93(10): 1224-5.

G McDowell, I Temple, CC Kirwan, NJ Bundred, CN McCollum, S Kumar, G Byrne.

Alteration in platelet function in patients with early breast cancer. Anticancer Research, 2005; 25(6B): 3963-6.

J Walls, C Marshall, CC Kirwan

Flexible Training for a Modern Surgical Workforce. Bulletin, 2006; 88 (2): 44-47.

CC Kirwan, E Nath, GJ Byrne, CN McCollum.

Prophylaxis for venous thromboembolism during treatment for cancer: questionnaire survey.

British Medical Journal, 2003; 327(7415): 597-8.

F Torella, SL Haynes, CC Kirwan, AN Bhatt, CN McCollum.

Acute normovolaemic haemodilution and intraoperative cell salvage in aortic surgery.

Journal of Vascular Surgery, 2002; 36:31-34.

AM Pullyblank, CC Kirwan, H Rigby and AR Dixon.

Is Routine Histological Reporting of Doughnuts Justified? Colorectal Disease, 2001; 3 (3): 198-200.