Revisiting occult cancer screening in patients with unprovoked venous thromboembolism

Cancer Screening in Patients with Unprovoked Thromboembolism: How to do it and Who Benefits?

“…Similarly, Prandoni et al concluded in a randomized, multicentre trial with 195 patients, that CT-based screening and faecal occult blood testing does not bring significant benefit over LS based on clinical criteria [10]. The Standard Diagnostic Procedures With or Without Fludeoxyglucose F 18 Positron Emission Tomography in Finding Cancer in Patients With a Blood Clot in a Vein (MVTEP) randomized trial is the largest to evaluate the inclusion of PET/CT in the screening, having shown that no more neoplasms were detected in a statistically significant percentage, but PET/CT had an important predictive value, with the risk of cancer being lower after negative PET/CT than after a negative LS [2,20,21]. A Cochrane review published in 2015 revealed that there was insufficient evidence that additional tests besides LS reduced morbidity or mortality [5,22].…”

Occult cancer and thromboembolism: current epidemiology and its practical implication

“…The risk of occult cancer development was shown to increase linearly with age. 21 As for the other factors, there were no conclusive findings to support their association with occult cancer detection, which might be due to a small number of patients with positive cancer diagnosis. Larger studies are needed to confirm the association of other risk factors with the rates of occult cancer detection.…”

“…First, some studies included younger patient populations, which are at lower risk of occult cancer. 15,21 Second, low--risk patients were included in analyses, such as those with estrogen -related VTE or with history of previous VTE. 16,21 Finally, recent studies excluded patients with simultaneous VTE and cancer diagnosis or those who were highly suspected of having cancer at the time of VTE diagnosis, 21 thus reducing the number of patients with newly diagnosed occult cancer.…”

Dilemmas in anticoagulation and use of inferior vena cava filters in venous thromboembolism; a survey of Respiratory Physicians, Haematologists and Medical Oncologists and a review of the literature

“…Unfortunately, The ACR/SIR, CIRSE and the AHA guidelines provide no further advice. [6][7][8] The development of a recurrent VTE despite anticoagulation raises the suspicion of an occult malignancy [35,36]. Eighty six percent of respondents recommended investigating for an occult malignancy (figure 3).…”