Deep Vein Thrombosis as a Predictor of Cancer

Abstract

An association between cancer and venous thrombosis has long been recognized. In an attempt to find whether venous thrombosis can serve as a reliable predictor of subsequent cancer, 196 cases of confirmed venous thrombosis treated over a seven-year period were reviewed. Of a total of 196 cases, 113 were found to suffer from primary type deep venous thrombosis (DVT), whereas 83 were allocated to secondary type DVT. Of 113 cases with primary DVT, 23 had suffered from recurrent episodes, whereas 90 had only a single episode. From the secondary DVT group of 83 patients, 14 suffered from recurrent episodes and 69 had a single episode. Of the patients in the primary DVT group, 2.65% (3/113) developed cancer subsequently, whereas none was detected among the group of 83 patients who had secondary DVT. In the group of 113 patients with primary DVT, the incidence was higher among those who had recurrent episodes (4.34%, 1/23) than among those who had a single episode (2.22%, 2/90). The overall incidence of cancer among 196 cases of DVT was found to be 1.53% (3/196). The findings do not support the routine screening of all DVT patients by expensive diagnostic modalities. These patients should rather be assessed by careful clinical examinations and baseline investigations. The detailed investigations should be resorted to if there is any suggestion of presence of occult malignancy by these simpler means. One should be more vigilant in case of patients suffering from primary type DVT, for the incidence in this group is significantly higher.

Venous Thromboembolism and Cancer: Risks and Outcomes

“…44 On the basis of results from cohort studies and clinical trials, Ϸ10% of persons presenting with idiopathic VTE are subsequently diagnosed with cancer over 5 to 10 years, and the diagnosis is established within the first year of presentation of DVT in Ͼ75% of cases. 5,[42][43][44][45][46][47] This likelihood of identifying occult cancer after an episode of idiopathic VTE is supported by 2 population registry studies. Using data from national hospital and cancer registries, Baron et al found that the standardized incidence ratio (SIR, the observed number of cases divided by the expected number of cases in the age-matched normal population) was 4.4 for cancer at 1 year after diagnosis of VTE.…”

“…4 Similarly, there is a higher incidence of subsequent cancer in patients with idiopathic thrombosis than in those with a definite but transient risk factor at the time of VTE (Table 1). 5,[42][43][44][45][46] The variation in reported incidence likely reflects the different definitions for idiopathic and secondary cases, and variation in the intensity of cancer surveillance in each study. In a pooled analysis of these studies, the odds ratio for subsequent cancer in patients presenting with idiopathic VTE compared with secondary VTE was 4.8.…”

Cancer Screening in Patients with Idiopathic Venous Thromboembolism - a Position Paper of the German Society of Hematology and Oncology Working Group on Hemostasis

“…This also applies to superficial thrombophlebitis [24,30]. Incidence numbers range from 1.5 to 10% newly diagnosed tumors after idiopathic VTE [22,31,32,33,34,35]. This wide range can be explained by differences in study methods and patient groups (e.g.…”

Screening for Cancer in Patients with Idiopathic Venous Thromboembolism: The Clinical Practice

“…Consensus does not exist about the precise diagnostic workup, in particular for the initial clinical evaluation. But data of several recent studies support the concept that the evaluation of patients with IVTE should include a thorough medical history, physical examination, some laboratory investigations, including blood count, liver enzymes, urinalysis, feces for occult blood tests and a chest X-ray [9,12,16,[19][20][21]. Additional testing should be guided by abnormalities detected by these investigations.…”