Primary venous and malignancy, is there any relationship?

Unlabelled: Deep venous thrombosis and pulmonary embolism can be the first manifestation of cancer. In light of this association screening for cancer has been proposed in patients with primary VTE to identify an undiagnosed malignancy.

Method: Descriptive, retrospective record review that includes 3244 patients from VA San Juan Caribbean system with diagnosis of lung (small and non-small cell), prostate, colon, rectum, liver, stomach, esophagus, pancreas and breast cancer, lymphoma or leukemia from 2005 to 2010 evaluated for primary VTE during five years prior to their malignancy diagnosis. Secondary outcomes evaluated were age and staging at the time of VTE diagnosis. The inclusion criteria were veterans with age 21 years old or more and with diagnosis of the above mentioned malignancies. The exclusion criteria were pregnancy five years to the diagnosis of malignancy, history of coagulopathy or use of anticoagulation at moment of the diagnosis of malignancy.

Results: 3244 records were reviewed. From the 2858 that met the inclusion criteria 22 (8%) had history of VTE five years before their malignancy, most of them (14%) with diagnosis of pancreatic malignancy. After we studied VTE by site of malignancy: 7% of pancreatic, 0.8% of prostate, 0.5% of colon, 0.6% of bladder, 0.8% of liver, 0.4% of lung, 1.1% of rectal cancer patients but none with leukemia, stomach, esophagus, breast cancer had VTE. Regarding patients with advanced metastatic cancer at the moment of their diagnosis, only 13% had a prior event of VTE.

Conclusion: Although at this point there is no clear indication to screen for malignancy in patients presenting primary VTE our results point out an increased number of VTE in patients with subsequent pancreatic cancer. More research is needed before further recommendations on cancer screening in patients with VTE.