Abstract Number: PB2117
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis
Background: The prevalence of occult cancer after unprovoked venous thromboembolism (VTE) appears to be lower than previously reported. As part of a conservative approach to cancer screening after unprovoked, a systems-review questionnaire, the ‘cancer-screening tool’ (CST), was introduced in the outpatient nurse-led clinic to promptly identify patients requiring further investigation. Inpatients continue to be assessed by the medical team. We sought to determine the incidence of cancer diagnosis following unprovoked deep vein thrombosis (DVT) and evaluate the use of the CST.
Aims: We sought to determine the incidence of cancer diagnosis following unprovoked deep vein thrombosis (DVT) and evaluate the use of the CST.
Methods: Clinical records of patients diagnosed with unprovoked DVT between 1st January and 31st December 2018 were retrospectively reviewed for 12 months following diagnosis. Provoked cases were excluded i.e. surgery, hospitalisation or lower-limb immobilisation (prior 12 weeks), pregnancy/postpartum, exogenous oestrogen use or cancer. Unprovoked cases included those associated with long-haul travel.
Results: 231 patients were diagnosed with DVT and 110 (44.5%) of these were classed as unprovoked. 74 (67.3%) were male. Median age was 56.5 years (range 19-97). Of unprovoked DVTs, 81 (73.6%) were diagnosed via the outpatient clinic. The remainder were inpatients. A total of 5 (4.5%) patients were diagnosed with cancer following DVT diagnosis and are summarised in Table 1. Of the 81 patients seen in DVT clinic, 57 (70.3%) had a CST completed. One had early consultant review due to the CST result and subsequent diagnosis of ovarian cancer.
Table 1: Patients diagnosed with cancer following DVT Diagnosis | |||||||
Age | DVT Diagnosis | D Dimer (ng/mL) | Inpatient vs clinic | CST /outcomes | Events following DVT | Cancer diagnosis | |
1 | 49 F | Proximal DVT 29/05/18 | >8000 | DVT clinic | CST performed: Bloating | Early review. Ca125 high, CT performed and referred to Gynaecology MDM. | 31/07/2018 Stage IIIc High Grade Serous Ovarian Cancer |
2 | 72 M | Distal DVT 17/05/18 | 1300 | DVT clinic | CST performed: LUTS only GGT 75 | GP referral in progress to renal clinic at time of DVT diagnosis. Virology tests in renal clinic: Active HCV. Ultrasound: focal lesion | 8/11/2018 Hepatocellular carcinoma |
3 | 75 F | Distal 4cm 8/02/18 Distal 3.2cm 14/02/18 | >8000 | DVT clinic | No CST as 4cm distal DVT and no extension on repeat scan. Not anti coagulated | Treated for pneumonia at time of DVT diagnosis. Repeat CXR abnormal and referred to Lung Multidisciplinary meeting. | 15/06/2018 Metastatic adenocarcinoma of likely lung primary |
4 | 56 M | Proximal 04/05/18 | >8000 | Inpatient | Admitted with obstructive jaundice | Raised Ca199, CT confirmed pancreatic mass | 10/05/2018 Metastatic adenocarcinoma of pancreatic primary |
5 | 69 M | Distal 29/06/18 | 670 | Inpatient | No symptoms on admission | CT AP performed on admission. Bladder diverticulum only. Haematuria 6/12 after DVT therefore referred to Urology. | 04/03/2019 High grade carcinoma in situ of bladder |
[Patients diagnosed with cancer following DVT Diagnosis]
Conclusions: Our findings confirm a continued low incidence of occult malignancy in unprovoked DVT. In the outpatient DVT clinic, the King’s CST is a helpful adjunct for the early identification of patients requiring further investigation.
To cite this abstract in AMA style:
Cox C, Roberts L, Guppy S, Patel R, Arya R, Czuprynska J. Use of a Cancer Screening Tool as Part of a Conservative Approach to Screening for Occult Malignancy after Unprovoked DVT: The King’s College Hospital Experience [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/use-of-a-cancer-screening-tool-as-part-of-a-conservative-approach-to-screening-for-occult-malignancy-after-unprovoked-dvt-the-kings-college-hospital-experience/. Accessed March 22, 2024.« Back to ISTH 2020 Congress
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