Types of occult cancer in stroke and the relation to smoking

Tybjerg, Anne Julie; Babore, Alejandro Daniel; Olsen, Tom Skyhøj; Andersen, Klaus Kaae

doi:10.1111/ane.13299

Cited by 9 publications

(15 citation statements)

References 18 publications

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“…Therefore, more efficient screen method for example positron emission tomography-computed tomography (PET-CT) might contribute to early detection of primary tumor. Clinicians need to be vigilant when they encounter patients who manifest as internal diseases such as stroke [ 6 , 7 , 8 , 9 ], thromboembolism [ 10 , 11 ] and dermatomyositis [ 12 ]. As occult NSCLC might be the fundamental cause of these non-cancer-related symptoms, the more refined examinations should be performed as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

“…Occult lung cancer, defined as the presence of malignant tumor cells in bronchial washing or sputum but demonstrated no tumor evidence by imaging [ 1 , 2 ], often manifests as metastasis diseases [ 3 , 4 , 5 ] or other internal diseases such as stroke [ 6 , 7 , 8 , 9 ], venous thromboembolism [ 10 , 11 ] and dermatomyositis [ 12 ]. When these patients develop apparent non-cancer-related symptoms, the vast majority may have already progressed to an advanced stage.…”

Section: Introductionmentioning

confidence: 99%

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Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

Cai

Yang

Wang

2022

JCM

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Background: The number of researches on occult non-small cell lung cancer (NSCLC) is modest. Herein, we defined the clinicopathological features, prognosis and survival outcome of this underappreciated tumor, with purpose of obtaining a clearer picture on this disease. Methods: The entire cohort was categorized into two groups (occult NSCLC and other NSCLC) and further into five groups (occult, T1, T2, T3 and T4). A least absolute shrinkage and selection operator (LASSO) penalized Cox regression model was performed to identify the prognostic indicators. A nomogram and a risk-classifying system were formulated. Kaplan–Meier with Log-rank method was carried out to compare overall survival (OS) and cancer specific survival (CSS) differences between groups. Results: 59,046 eligible NSCLC cases (occult NSCLC: 1158 cases; other NSCLC: 57,888 cases) were included. Occult NSCLC accounted for 2.0% of the included cases. Multivariate analysis revealed that age, sex, tumor location, histology, grade and surgery were prognostic factors for OS. The corresponding prognostic nomogram classified occult NSCLC patients into low-risk and high-risk group, and its performance was acceptable. Survival curves demonstrated that occult NSCLC patients exhibited worse survivals than other NSCLC. In further analyses, the survival of low-risk occult NSCLC and stage T3 NSCLC were comparable, and the high-risk occult NSCLC patients still owned the worst survival rate. Conclusions: Occult NSCLC was an aggressive tumor with poor prognosis, and surgery was the preferred treatment. More attention should be paid to this overlooked disease due to no evidence of tumor imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

Cai

Yang

Wang

2022

JCM

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“… 4 , 13 – 15 Solid tumors in advanced stage disease of the lung, pancreatic, and colorectal cancers seem to carry the highest stroke risk. 4 , 11 , 16 Other studies reported high incidence of stroke in breast and prostate cancer. 3 , 9 ( Box 1 ) A vast increase in stroke risk is also seen in metastatic disease, indicating a more advanced disease.…”

Section: Association Between Cancer and Different Subtypes Of Strokementioning

confidence: 99%

“… 3 , 9 ( Box 1 ) A vast increase in stroke risk is also seen in metastatic disease, indicating a more advanced disease. 15 Stroke can be the initial presentation of cancer 16 or follow a cancer diagnosis, however, 13 and the risk of stroke remains elevated even over 10 years following cancer diagnosis. 15 …”

Section: Association Between Cancer and Different Subtypes Of Strokementioning

confidence: 99%

“…In these studies, male sex, older age, and a history of smoking were more often present in patients with occult cancer suffering a stroke than in the stroke population without cancer. 14 , 16 Regarding stroke features typically associated with occult cancer, undetermined stroke etiology and involvement of multiple vascular territories on neuroimaging are the most important. 12 , 18 Markers of inflammation such as increased levels of CRP, hypoalbuminemia and anemia, and markers of upregulated coagulation activity, mainly elevated D-dimer, fibrinogen monomer, and fibrinogen were associated with cancer after stroke.…”

Section: Which Stroke Patients Are Good Candidates For Screening For ...mentioning

confidence: 99%

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Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach

Woock

Martinez‐Majander

Seiffge

et al. 2022

Ther Adv Neurol Disord

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The association between stroke and cancer is well-established. Because of an aging population and longer survival rates, the frequency of synchronous stroke and cancer will become even more common. Different pathophysiologic mechanisms have been proposed how cancer or cancer treatment directly or via coagulation disturbances can mediate stroke. Increased serum levels of D-dimer, fibrin degradation products, and CRP are more often seen in stroke with concomitant cancer, and the clot retrieved during thrombectomy has a more fibrin- and platelet-rich constitution compared with that of atherosclerotic etiology. Multiple infarctions are more common in patients with active cancer compared with those without a cancer diagnosis. New MRI techniques may help in detecting typical patterns seen in the presence of a concomitant cancer. In ischemic stroke patients, a newly published cancer probability score can help clinicians in their decision-making when to suspect an underlying malignancy in a stroke patient and to start cancer-screening studies. Treating stroke patients with synchronous cancer can be a delicate matter. Limited evidence suggests that administration of intravenous thrombolysis appears safe in non-axial intracranial and non-metastatic cancer patients. Endovascular thrombectomy is probably rather safe in these patients, but probably futile in most patients placed on palliative care due to their advanced disease. In this topical review, we discuss the epidemiology, pathophysiology, and prognosis of ischemic and hemorrhagic strokes as well as cerebral venous thrombosis and concomitant cancer. We further summarize the current evidence on acute management and secondary preventive therapy.

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Association of Stroke at Young Age With New Cancer in the Years After Stroke Among Patients in the Netherlands

et al. 2023

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ImportanceStroke may be a first manifestation of an occult cancer or may be an indicator of an increased cancer risk in later life. However, data, especially for younger adults, are limited.ObjectivesTo assess the association of stroke with new cancer diagnoses after a first stroke, stratified by stroke subtype, age, and sex, and to compare this association with that in the general population.Design, Setting, and ParticipantsThis registry- and population-based study included 390 398 patients in the Netherlands aged 15 years or older without a history of cancer and with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) between January 1, 1998, and January 1, 2019. Patients and outcomes were identified through linkage of the Dutch Population Register, the Dutch National Hospital Discharge Register, and National Cause of Death Register. Reference data were gathered from the Dutch Cancer Registry. Statistical analysis was performed from January 6, 2021, to January 2, 2022.ExposureFirst-ever ischemic stroke or ICH. Patients were identified by administrative codes from the International Classification of Diseases, Ninth Revision, and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.Main Outcomes and MeasuresThe primary outcome was the cumulative incidence of first-ever cancer after index stroke, stratified by stroke subtype, age, and sex, compared with age-, sex- and calendar year–matched peers from the general population.ResultsThe study included 27 616 patients aged 15 to 49 years (median age, 44.5 years [IQR, 39.1-47.6 years]; 13 916 women [50.4%]; 22 622 [81.9%] with ischemic stroke) and 362 782 patients aged 50 years or older (median age, 75.8 years [IQR, 66.9-82.9 years]; 181 847 women [50.1%]; 307 739 [84.8%] with ischemic stroke). The cumulative incidence of new cancer at 10 years was 3.7% (95% CI, 3.4%-4.0%) among patients aged 15 to 49 years and 8.5% (95% CI, 8.4%-8.6%) among patients aged 50 years or older. The cumulative incidence of new cancer after any stroke among patients aged 15 to 49 years was higher among women than men (Gray test statistic, 22.2; P &lt; .001), whereas among those aged 50 years or older, the cumulative incidence of new cancer after any stroke was higher among men (Gray test statistic, 943.1; P &lt; .001). In the first year after stroke, compared with peers from the general population, patients aged 15 to 49 years were more likely to receive a diagnosis of a new cancer after ischemic stroke (standardized incidence ratio [SIR], 2.6 [95% CI, 2.2-3.1]) and ICH (SIR, 5.4 [95% CI, 3.8-7.3]). For patients aged 50 years or older, the SIR was 1.2 (95% CI, 1.2-1.2) after ischemic stroke and 1.2 (95% CI, 1.1-1.2) after ICH.Conclusions and RelevanceThis study suggests that, compared with the general population, patients aged 15 to 49 years who have had a stroke may have a 3- to 5-fold increased risk of cancer in the first year after stroke, whereas this risk is only slightly elevated for patients aged 50 years or older. Whether this finding has implications for screening remains to be investigated.

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Types of occult cancer in stroke and the relation to smoking

Cited by 9 publications

References 18 publications

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach

Association of Stroke at Young Age With New Cancer in the Years After Stroke Among Patients in the Netherlands

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