Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism

Abstract

Summary. Patients with acute venous thromboembolism have an increased risk for occult malignancy. Limited screening for these malignancies has become common practice but little is known about its usefulness. This is a prospective cohort followup study in consecutive patients with acute venous thromboembolism. All patients underwent a routine clinical evaluation for malignancy, if negative, followed by a limited diagnostic work-up consisting of abdominal and pelvic ultrasound and laboratory markers for malignancy. Clinical follow-up was conducted to detect screening failures. The routine clinical evaluation was performed in 864 patients and revealed malignancy in 34 (3.9%) of them. Among the remaining 830 patients the limited diagnostic work-up revealed 13 further malignancies. During follow-up, cancer became symptomatic in 14 patients who were negative for cancer at screening (sensitivity of limited diagnostic work-up, 48.1%). Malignancies that were identified by the limited diagnostic work-up were early stage in 61% of cases vs. 14% in cases occurring during follow-up. Most patients with occult cancer had idiopathic venous thromboembolism and were older than 70 years. A limited diagnostic work-up for occult cancer in patients with venous thromboembolism has the capacity to identify approximately one-half of the malignancies. Identified malignancies were predominantly in an early stage.

Extensive screening for occult cancer in unprovoked venous thromboembolism: not so useful?

“…The rate of cancer detection in this study is significantly lower than expected by authors based on previous studies [1,2]. Therefore, the study might be underpowered to detect a significant difference between groups.…”

“…Approximately 10 % of patients with unprovoked venous thromboembolism (VTE) will be diagnosed with cancer within 1 year of their thrombotic event; some studies have suggested that a limited screening strategy for occult cancer in patient with unprovoked VTE-including history taking, physical examination, routine blood testing, and chest radiography-is adequate to detect most occult cancers, while others have suggested that a more extensive screening strategy [e.g., incorporating ultrasonography or computed tomography (CT) of the abdomen and pelvis, measurement of tumor markers, or a combination of these] can increase the rate of detection of occult cancer [1,2].…”

The Association of Active Cancer With Venous Thromboembolism Location: A Population-Based Study

“…In a large registry of VTE patients in Spain, a limited diagnostic work-up for occult cancer in patients with VTE identified about half of the prevalent cancers, and these cancers were at an earlier stage compared with those identified during follow-up (61% vs 14%). 28 In a recent systematic review, the period prevalence of previously undiagnosed cancer in patients with idiopathic VTE was 6.1% at baseline and 10.0% from baseline to 12 months. 29 An extensive screening strategy increased the proportion of previously undiagnosed cancers detected from 49% to 70%.…”

The Mystery Hidden by Pulmonary Embolism: Colonic Adenocarcinoma

“…There has been a prospective cohort follow-up study in consecutive patients with acute VTE. The study was conducted with 864 patients, and 34 of them (3.9%) had malignancies (1) . Most patients with occult cancer were aged more than 70 years.…”

“…In most patients with occult cancer, the cancer is accompanied by idiopathic venous thromboembolism (VTE) (1) . The association between VTE and cancer has been well known, and the primary factor responsible for cancer-induced VTE is considered to depend on a hypercoagulative state induced by the cancer itself (2) .…”