Question

A 48-year-old male was started on anticoagulation for unprovoked deep vein thrombosis (common femoral vein and popliteal vein) with pulmonary embolism. He has following doubts after reading about DVT on internet and needs a counselling session with the treating vascular surgeon:
What are the chances of developing a malignancy and why?

Hint:

For patients with unprovoked DVT, screening for malignancy is essential, especially if there are additional risk factors or unexplained symptoms.

Answer 1

Step 1: Connection between DVT and malignancy.
Unprovoked DVT is often associated with an increased risk of underlying malignancy. This is because certain cancers can cause hypercoagulability, a condition in which the blood is more prone to clotting. The most common cancers associated with DVT are those of the pancreas, lungs, and gastrointestinal tract.

Step 2: Risk factors for malignancy.
The risk of malignancy is higher in individuals with unprovoked DVT, particularly those who are older or have a family history of cancer. Additional risk factors include unexplained weight loss, fatigue, or a personal history of cancer.

Step 3: Clinical approach.
For patients with unprovoked DVT, it is recommended to rule out malignancy with further testing. This may involve imaging studies (e.g., CT scans, ultrasounds) and blood tests (e.g., tumor markers). The decision to perform extensive cancer screening is based on the patient's age, family history, and the presence of additional symptoms.

Step 4: Conclusion.
The risk of developing a malignancy in the presence of unprovoked DVT is significant. This association necessitates further workup to rule out any underlying cancers, particularly in high-risk individuals.