Abstract
Unprovoked venous thromboembolism (VTE) can be the first sign of an occult cancer. The rate of occult cancer detection within 12 months of a newly diagnosed unprovoked VTE is approximately 5%. Therefore, it is appealing for clinicians to screen patients with unprovoked VTE for occult cancer, as it could potentially decrease cancer-related mortality and morbidity and improve quality of life. However, several randomized controlled trials have failed to report that an extensive occult cancer screening strategy (e.g., computed tomography of the abdomen/pelvis) is improving these patient-important outcomes. Therefore, clinical guidance documents suggest that patients should only undergo a limited screening strategy including a thorough medical history, physical examination, basic laboratory investigations (i.e., complete blood count and liver function tests), chest X-ray, as well as age- and gender-specific cancer screening (breast, cervical, colon and prostate). More intensive occult cancer screening including additional investigations is not routinely recommended. This narrative review will focus on the epidemiology, timing, and evidence regarding occult cancer detection in patients with unprovoked VTE.
Highlights
The association between venous thromboembolism (VTE) and potential occult cancer is well established
This review focuses on the epidemiology, risk factors, timing, and effectiveness of screening strategies for occult cancer detection among patients with unprovoked VTE
A post-hoc analysis of a randomized controlled trial of patients with an unprovoked VTE comparing a limited to a more extensive occult cancer screening strategy reported that age, previously provoked VTE, and current smoking were associated with a higher hazard of having a diagnosis of cancer in the year following VTE diagnosis [6]
Summary
The association between venous thromboembolism (VTE) and potential occult cancer is well established. This review focuses on the epidemiology, risk factors, timing, and effectiveness of screening strategies for occult cancer detection among patients with unprovoked VTE. We will use two patient-cases to highlight important knowledge gaps and apply the available evidence to provide some clinical recommendations for the clinical scenario. The aim of this narrative review is to revisit the evidence regarding occult cancer screening in patients with acute unprovoked VTE. We aim on assessing potential risk factors associated with occult cancer in patients with unprovoked VTE. This is highly relevant, as future trials are ongoing and are focusing on high-risk patients. This review assesses the current knowledge and provides a framework for future evidence using the most recent high-quality evidence (i.e., randomized controlled trials) when available
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
