Occult Cancer Workup in Idiopathic Venous Thromboembolism

Idiopathic VTE comprises about 40% of total VTE cases and may be an early sign of occult cancer. In patients with acute unprovoked VTE, the risk of having occult cancer is increased by four-folds compared to patients with provoking risk factors. Despite evidence that occult malignancy may be associated with unprovoked VTE cases, there is a paucity of data and no specific guideline regarding whether to perform occult cancer screening and what investigations to include. The National Institute for Health Care Excellence (NICE) guidelines suggest that idiopathic VTE cases should undergo extensive history taking, a comprehensive physical examination, a chest X-ray, basic laboratory investigations, and urinalysis. For now, only ageappropriate cancer screening along with complete history, and physical examination are advised in idiopathic VTE cases, with more focused evaluation depending on the initial findings. Further studies are required to assess the extent and benefits of extensive occult cancer screening in patients with idiopathic VTE.

Keywords: Cancer-associated thrombosis, Cancer screening, Idiopathic VTE, Occult cancer, Risks of VTE in cancer, Thrombosis, Thrombosis in malignancy, VTE in overt cancer, VTE Screening in cancer.