Venous Thromboembolism and Cancer

Case Presentation 1: A 64-year-old man with prostate cancer who recently underwent radical retropubic prostatectomy presented to the emergency department with sudden-onset exertional dyspnea and chest heaviness. On physical examination, he was tachycardic with a heart rate of 110 beats per minute, normotensive with a blood pressure of 100/76 mm Hg, and hypoxemic with an oxygen saturation of 88% on room air. Left lower extremity edema and calf tenderness were noted. Contrast-enhanced chest computed tomography demonstrated bilateral segmental pulmonary embolism (PE) without right ventricular enlargement. A left lower extremity venous ultrasound documented left femoral, popliteal, and calf deep vein thrombosis.Case Presentation 2: A 70-year-old woman with renal cell carcinoma underwent resection of a solitary right upper lobe metastatic pulmonary nodule and was referred to the Vascular Medicine clinic after surveillance chest computed tomography performed 1-month postoperatively demonstrated a right lobar PE. She noted fatigue since her surgery but denied any dyspnea or chest discomfort. On physical examination, her heart rate was 82 beats per minute, blood pressure was 102/66 mm Hg, and oxygenation was 96% on room air. Cardiac and pulmonary examinations were unremarkable.Although the association between cancer and venous thromboembolism (VTE) was first noted in 1823 by Bouillard, Trousseau provided the most detailed early description in 1865. VTE is now recognized as a common cause of morbidity and mortality in patients with cancer. Increasing life expectancy attributable to advances in cancer therapy and greater use of imaging for cancer surveillance have contributed to the growing incidence of VTE in patients with malignancy. The rate of symptomatic VTE in patients with cancer who have been hospitalized approaches 5%.1 VTE, especially when unprovoked, may herald an impending diagnosis of cancer in a subset of patients without known malignancy.Although the frequency of VTE is considered highest among patients with solid …