Download PDF
Hamostaseologie 2021; 41(01): 042-047
DOI: 10.1055/a-1339-7328
Review Article

Screening for Cancer in Patients with Acute Venous Thromboembolic Disease[#]

Marc Blondon
1   Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals and Faculty of Medicine, Genève, Switzerland
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Active cancer causes approximately 25% of all acute events of venous thromboembolism (VTE). While most of the cancer diagnoses are known or clinically apparent at the time of VTE, care providers and patients may be worried about the 3 to 8% risk of occult cancer occurring in the year after VTE. Several studies have compared limited to extensive cancer screening after acute VTE, especially with the addition of abdominal computed tomography (CT) or whole-body PET-CT, with the hope to shorten the time to cancer diagnosis and lead to less advanced cancer stages. These studies have not shown improved clinical outcomes with an extensive screening, and have led to current recommendations of limited screening for cancer in patients with acute VTE, including unprovoked cases. Several risk assessment models have been developed to identify patients at greatest risk of occult cancer, however, with low discriminative performances and no current clinical usefulness. Some clinical situations may empirically deserve a more thorough cancer screening, such as unprovoked upper extremity deep vein thrombosis (DVT), bilateral leg DVT, descending leg DVT, or recurrent VTE during anticoagulation.

Keywords

venous thrombosis - cancer - pulmonary embolism - diagnosis

# Invited review for the 65th Annual Meeting of the Society of Thrombosis and Hemostasis Research (GTH 2021).




Publication History

Received: 08 November 2020

Accepted: 17 December 2020

Article published online:
15 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Prandoni P, Lensing AWA, Piccioli A. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedGoogle Scholar
  • 2 van Es N, Le Gal G, Otten H-M. et al. Screening for occult cancer in patients with unprovoked venous thromboembolism: a systematic review and meta-analysis of individual patient data. Ann Intern Med 2017; 167 (06) 410-417
    CrossrefPubMedGoogle Scholar
  • 3 Carrier M, Le Gal G, Wells PS, Fergusson D, Ramsay T, Rodger MA. Systematic review: the Trousseau syndrome revisited: should we screen extensively for cancer in patients with venous thromboembolism?. Ann Intern Med 2008; 149 (05) 323-333
    CrossrefPubMedGoogle Scholar
  • 4 Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 2011; 171 (09) 831-837
    CrossrefPubMedGoogle Scholar
  • 5 Jara-Palomares L, Otero R, Jiménez D. et al; RIETE Investigators. Development of a risk prediction score for occult cancer in patients with VTE. Chest 2017; 151 (03) 564-571
    CrossrefPubMedGoogle Scholar
  • 6 Kraaijpoel N, van Es N, Raskob GE. et al. Risk scores for occult cancer in patients with venous thromboembolism: a post hoc analysis of the Hokusai-VTE study. Thromb Haemost 2018; 118 (07) 1270-1278
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Weitz JI, Haas S, Ageno W. et al; GARFIELD-VTE Investigators. Cancer associated thrombosis in everyday practice: perspectives from GARFIELD-VTE. J Thromb Thrombolysis 2020; 50 (02) 267-277
    CrossrefPubMedGoogle Scholar
  • 8 Piccioli A, Lensing AWA, Prins MH. et al; SOMIT Investigators Group. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost 2004; 2 (06) 884-889
    CrossrefPubMedGoogle Scholar
  • 9 Carrier M, Lazo-Langner A, Shivakumar S. et al; SOME Investigators. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med 2015; 373 (08) 697-704
    CrossrefPubMedGoogle Scholar
  • 10 Robin P, Le Roux P-Y, Planquette B. et al; MVTEP Study Group. Limited screening with versus without (18)F-fluorodeoxyglucose PET/CT for occult malignancy in unprovoked venous thromboembolism: an open-label randomised controlled trial. Lancet Oncol 2016; 17 (02) 193-199
    CrossrefPubMedGoogle Scholar
  • 11 Prandoni P, Bernardi E, Valle FD. et al. Extensive computed tomography versus limited screening for detection of occult cancer in unprovoked venous thromboembolism: a multicenter, controlled, randomized clinical trial. Semin Thromb Hemost 2016; 42 (08) 884-890
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Van Doormaal FF, Terpstra W, Van Der Griend R. et al. Is extensive screening for cancer in idiopathic venous thromboembolism warranted?. J Thromb Haemost 2011; 9 (01) 79-84
    CrossrefPubMedGoogle Scholar
  • 13 Robin P, Le Roux P-Y, Le Moigne E. et al. Additional testing following screening strategies for occult malignancy diagnosis in patients with unprovoked venous thromboembolism. Thromb Res 2017; 155: 6-9
    CrossrefPubMedGoogle Scholar
  • 14 Jara-Palomares L, van Es N, Praena-Fernandez JM. et al. Relationship between type of unprovoked venous thromboembolism and cancer location: an individual patient data meta-analysis. Thromb Res 2019; 176: 79-84
    CrossrefPubMedGoogle Scholar
  • 15 Mulder FI, Carrier M, van Doormaal F. et al. Risk scores for occult cancer in patients with unprovoked venous thromboembolism: results from an individual patient data meta-analysis. J Thromb Haemost 2020; 18 (10) 2622-2628
    CrossrefPubMedGoogle Scholar
  • 16 Wurdinger T, In't Veld SGJG, Best MG. Platelet RNA as pan-tumor biomarker for cancer detection. Cancer Res 2020; 80 (07) 1371-1373
    CrossrefPubMedGoogle Scholar
  • 17 Rance A, Emmerich J, Guedj C, Fiessinger JN. Occult cancer in patients with bilateral deep-vein thrombosis. Lancet 1997; 350 (9089): 1448-1449
    CrossrefPubMedGoogle Scholar
  • 18 Seinturier C, Bosson J-L, Colonna M, Imbert B, Carpentier PH. Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study. J Thromb Haemost 2005; 3 (07) 1362-1367
    CrossrefPubMedGoogle Scholar
  • 19 Bura A, Cailleux N, Bienvenu B. et al. Incidence and prognosis of cancer associated with bilateral venous thrombosis: a prospective study of 103 patients. J Thromb Haemost 2004; 2 (03) 441-444
    CrossrefPubMedGoogle Scholar
  • 20 Ageno W, Riva N, Schulman S. et al. Long-term clinical outcomes of splanchnic vein thrombosis: results of an international registry. JAMA Intern Med 2015; 175 (09) 1474-1480
    CrossrefPubMedGoogle Scholar
  • 21 Valeriani E, Di Nisio M, Riva N. et al; International Registry on Splanchnic Vein Thrombosis (IRSVT) Study Group. Clinical history of cancer-associated splanchnic vein thrombosis. J Thromb Haemost 2020; ;(epub ahead of print) DOI: 10.1111/jth.15214.
    CrossrefPubMedGoogle Scholar
  • 22 Søgaard KK, Farkas DK, Pedersen L, Sørensen HT. Splanchnic venous thrombosis is a marker of cancer and a prognostic factor for cancer survival. Blood 2015; 126 (08) 957-963
    CrossrefPubMedGoogle Scholar
  • 23 Smalberg JH, Arends LR, Valla DC, Kiladjian J-J, Janssen HLA, Leebeek FWG. Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis. Blood 2012; 120 (25) 4921-4928
    CrossrefPubMedGoogle Scholar
  • 24 Delluc A, Antic D, Lecumberri R, Ay C, Meyer G, Carrier M. Occult cancer screening in patients with venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost 2017; 15 (10) 2076-2079
    CrossrefPubMedGoogle Scholar
  • 25 National Institute for Health and Care Excellence (NICE). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. November 2020:1–47
    PubMedGoogle Scholar
  • 26 Coyle K, Carrier M, Lazo-Langner A. et al. Cost effectiveness of the addition of a comprehensive CT scan to the abdomen and pelvis for the detection of cancer after unprovoked venous thromboembolism. Thromb Res 2017; 151: 67-71
    CrossrefPubMedGoogle Scholar
  • 27 Mandalà M, Falanga A, Roila F. ESMO Guidelines Working Group. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2011; 22 (Suppl. 06) vi85-vi92
    CrossrefPubMedGoogle Scholar
  • 28 OFSP data. Accessed Nov 2, 2020 at: https://www.bag.admin.ch/bag/fr/home/zahlen-und-statistiken/zahlen-fakten-nichtuebertragbare-krankheiten/krebserkrankungen-schweiz.html
    PubMedGoogle Scholar