[Screening for cancer in case of venous thromboembolism: when and how?] / Quand et comment rechercher un cancer en cas de maladie thromboembolique veineuse ?

ABSTRACT

Screening for cancer in case of venous thromboembolism when and how? Cancer associated thrombosis (cat) is an important challenge. When venous thromboembolism (vte) occurs without any identified risk factors, the risk of cat raises the question of a hidden cancer and the need for an extensive screening or not. Several series have shown a prevalence between 5% and 10% of cancer when non provoqued vte is diagnosed. Most of cancers occur during the following year of vte. If we consider diagnosing the cancer in early stage, we might improve the patient outcome and reduce cancer mortality. A simple screening, including clinical examina¬tion, personal and familial history of cancer, basic laboratory tests and recommended age and sex testing is mandatory. Other exams are considered as useless at present time. Whether a tep-scan, prescribed in patients older than 50, brings a clinical benefit, is still unresolved. Screening for cancer in case of venous thromboembolism when and how? Cancer associated thrombosis (cat) is an important challenge. When venous thromboembolism (vte) occurs without any identified risk factors, the risk of cat raises the question of a hidden cancer and the need for an extensive screening or not. Several series have shown a prevalence between 5% and 10% of cancer when non provoqued vte is diagnosed. Most of cancers occur during the following year of vte. If we consider diagnosing the cancer in early stage, we might improve the patient outcome and reduce cancer mortality. A simple screening, including clinical examina¬tion, personal and familial history of cancer, basic laboratory tests and recommended age and sex testing is mandatory. Other exams are considered as useless at present time. Whether a tep-scan, prescribed in patients older than 50, brings a clinical benefit, is still unresolved.

Quand et comment rechercher un cancer en cas de maladie thromboembolique veineuse ? L'association thrombose et cancer est connue depuis longtemps et pose des problèmes diagnostiques et thérapeutiques spécifiques. La maladie thromboembolique veineuse (mtev) peut précéder le cancer et servir de signe d'alerte. Plusieurs publications font état d'une prévalence comprise entre 5 et 10 % de cancer occulte en cas de mtev non provoquée. La plupart des cancers apparaissent dans l'année qui suit le diagnostic de mtev. Dépister un cancer au stade infraclinique, au moment du diagnostic de la thrombose, permettrait de diminuer le risque d'extension du cancer et d'améliorer le pronostic des patients. Une recherche de cancer, simple, incluant interrogatoire, examen clinique et bilan biologique minimal, sans examens complémentaires inutiles et adaptée aux facteurs de risque, doit donc être effectuée. La question est aujourd'hui de savoir si une stratégie plus extensive, comprenant un tep-scan, notamment chez les patients de plus de 50 ans, apporte un bénéfice clinique.