"A nickel's worth of cancer can give a dollar's worth of clot." Dr. Leo Zacharski, is fond of using this expression to describe the phenomenon of clinically overt venous thromboembolism (VTE) triggered by clinically occult cases of cancer. Although Armand Trousseau first described the association between cancer and thrombosis and later developed cancer-associated thrombosis himself, it was Illtyd James and Matheson who in 1935 first promulgated the idea that clinically inapparent cancer could trigger thrombosis. They reported on a seemingly cancer-free patient who developed symptomatic cancer 2 months after presentation with thrombosis and made the conjecture that cancer was already present and that the tumor cells activated the thrombotic process. We now recognize that it takes only a small number of cancer cells with a procoagulant phenotype to initiate coagulation reactions that host coagulation proteins then amplify to produce massive clots . Indeed, compared with the general population, patients with VTE are at substantially increased risk for harboring or subsequently developing cancer.
Whether to undertake an arduous search for concealed cancer in patients with idiopathic VTE is a question that has never been more relevant. We have modern screening tests that detect with great regularity asymptomatic malignant conditions in otherwise healthy individuals, and we commonly cure early-stage cancer. However, screening for cancer has downsides: expense, potential for psychological and physical harm due to false-positive results, and complications of procedures instigated by true- and false-positive test results. Two questions are therefore pertinent: How often do we find cancer if we look hard enough in patients with VTE, and is the search worthwhile? The study by Carrier and colleagues nicely addresses the first question but does not answer the second.
Editorial in the same issue is worth reading.
Whether to undertake an arduous search for concealed cancer in patients with idiopathic VTE is a question that has never been more relevant. We have modern screening tests that detect with great regularity asymptomatic malignant conditions in otherwise healthy individuals, and we commonly cure early-stage cancer. However, screening for cancer has downsides: expense, potential for psychological and physical harm due to false-positive results, and complications of procedures instigated by true- and false-positive test results. Two questions are therefore pertinent: How often do we find cancer if we look hard enough in patients with VTE, and is the search worthwhile? The study by Carrier and colleagues nicely addresses the first question but does not answer the second.
Editorial in the same issue is worth reading.
