my personal edition > thrombosis > news


  E-Mail this DGReview to a colleague

DGReview

Detecting Underlying Malignancy in Idiopathic Deep Venous Thrombosis

The incidence of cancer in patients with idiopathic deep venous thrombosis (IDVT) is twice as high as in those with secondary DVT (SDVT) and is high enough to warrant evaluation of underlying malignancy, according to a retrospective cohort study. Moreover, use of patient history, physical examination, simple laboratory tests, and a routine chest x-ray are specific and sensitive enough to detect occult malignancy.

An association between DVT and cancer is well recognised; however, it is unclear whether the incidence of cancer is high enough to justify an evaluation for occult cancer and how extensive of an evaluation is warranted.

Anke Ronsdorf, MD, and colleagues at the University Hospital of Basel, Switzerland, conducted a retrospective study to determine the incidence of cancer in a cohort of patients with confirmed DVT.

The study included 485 patients with idiopathic and secondary DVT who had not been diagnosed with cancer upon hospital admission. During hospitalisation, patient history, clinical examination, simple laboratory tests, and a routine chest x-ray and abdominal ultrasound were evaluated to detect underlying malignancies. The incidence of cancer was determined during hospital stay and at a mean follow-up of 33 months.

A malignant disorder was detected more frequently during hospitalisation in patients with IDVT than in those with SDVT. Specifically, 4.7% of patients with IDVT and 2% of those with SDVT were diagnosed with cancer during hospitalisation, representing an odds ratio of 2.4. Half of these patients died within the first year of diagnosis.

The use of history, physical examination and/or chest x-ray to identify potential malignancy resulted in a sensitivity of 88% and a specificity of 79%. The addition of abdominal ultrasound identified 2 additional cancers.

Hospital evaluation detected 3 cases of prostate cancer, 4 cases of lung cancer, 3 cases of pancreatic cancer and 3 cases of colorectal cancer.

About 8% of patients with IDVT and 4.4% of those with SDVT were diagnosed with cancer after hospitalisation. This represents an incidence rate of 1.36 per 100 patient-years in the IDVT group and 0.85 per 100 patient-years in the SDVT group.

Cancers diagnosed in this group included 5 lymphoproliferative disorders, 4 colorectal cancers, and 4 lung cancers. Notably, less than half of these patients survived longer than 6 months after diagnosis.

The authors conclude that "our study confirms the clinical wisdom that an idiopathic DVT can in fact be a marker for undiagnosed cancer." They therefore propose that "patients with IDVT have a prevalence and incidence of cancer large enough to justify an evaluation for an underlying malignant disorder."



Swiss Med Wkly 2003 Nov 1;133:41-42:567-74. "Search for occult malignancy in patients with deep venous thrombosis. Results of a retrospective cohort study"

E-Mail this DGReview to a colleague

To print, use this version