title: Occult malignancy in patients with venous thromboembolism: risk indicators and a diagnostic screening strategy.
abstract: BACKGROUND
  The study was designed to analyse the risk indicators for a possible underlying malignancy and to evaluate whether extensive cancer screening is necessary in all patients with venous thromboembolism or not.
  
  
  METHODS
  In total, 126 patients with idiopathic deep venous thrombosis, and 121 patients with secondary deep venous thrombosis of lower extremity and without a known malignancy were studied. A diagnostic screening workup including a clinical history, physical examination, complete blood count, blood sedimentation rate, basic biochemistry panel including hepatic and renal function tests, prostate-specific antigen, a chest X-ray and an abdominopelvic ultrasonography was performed for all patients.
  
  
  RESULTS
  Suspicious findings suggesting an underlying cancer, previous history of venous thromboembolism, bilateral venous thrombosis and associated thrombosis in unusual sites were significantly more common in patients with idiopathic venous thrombosis. A malignancy was detected in 10 of the 126 patients (7.9%) without a known risk factor for deep venous thrombosis. During the follow-up period, a diagnosis of malignancy was established in two patients in the same group.
  
  
  CONCLUSIONS
  The risk of an underlying malignancy in patients with idiopathic venous thromboembolism is significantly higher. A moderate screening strategy has the capacity to identify the majority of the malignancies in such patients. We advocate simple laboratory tests, a chest X-ray and an abdominopelvic ultrasonography in order to search for an occult malignancy. A more extensive screening strategy may be considered for patients with suspicious findings for cancer, recurrent or bilateral venous thromboembolism and associated thrombosis in unusual sites.
authors.affiliation: Division of Cardiovascular Surgery, Ankara Oncology Training and Research Hospital, Turkey. loktar@isnet.net.tr
authors.forename: G L
authors.initials: GL
authors.lastname: Oktar
authors.forename: E G
authors.initials: EG
authors.lastname: Ergul
authors.forename: U
authors.initials: U
authors.lastname: Kiziltepe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000150:complications / Q000175:diagnosis*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology* / Q000473:pathology