Page 16 - JCTR-11-4

Journal of Clinical and
Translational Research Hidden cancer after VTE

Table 2. Comparison of cancer types and stages detected in randomized controlled trials for occult cancer in patients with
unprovoked venous thromboembolism
Study Intervention Period Cancers, Types of cancer (n) Early Advanced
n stages* stages**
Piccioli et al. 16 Extensive Initial 13 Bladder (2), lung (2), kidney (1), adrenal gland (1), 12 1
screening stomach (1), liver (1), uterus (1), breast (1), ovary
(1), colon (1), prostate (1)
Follow-up 1 Lung (1) 1 ―
Limited Initial 0 ― ― ―
screening Follow-up 10 Lung (1), colon (2), prostate (2), pancreas (2), breast 2 8
(1), stomach (1), bladder (1)
Carrier et al. 17 Extensive Initial 14 Colorectal (3), cholangiocarcinoma (2), lymphoma NA NA
screening (3), breast (2), urologic (3), cancer of unknown
primary (1)
Follow-up 5 Acute leukemia (1), gynecologic (1), colorectal (1), NA NA
prostate (1), melanoma (1)
Limited Initial 10 Gynecologic (3), melanoma (1), prostate (2), NA NA
screening pancreatic (2), cholangiocarcinoma (1), lymphoma
(1)
Follow-up 4 Acute leukemia (1), gynecologic (1), colorectal (1), NA NA
pancreatic (1)
Prandoni et al. 18 Extensive Initial 10 Kidney (3), ovary (1), adrenal gland (1), breast and 7 3
screening lung (1), lung (2), stomach (1), pancreas (1)
Follow-up 2 Stomach (1), bladder (1) ― 2
Limited Initial 8 Colon (1), liver (1), breast (1), lung (non-small cell) NA NA
screening (1), kidney (1), prostate (1), stomach (1), esophagus
(1)
Follow-up 2 Breast (1), colon (1) NA NA
Robin et al. 19 PET/CT Initial 11 Polycythemia (1), testicle (1), pancreas (1), uvula 7 4
(1), prostate (3), lymphoma (1), lung (1), colon (1),
ovary and uterus (1)
Follow-up 1 Colon (1) ― 1
Limited Initial 4 Prostate (1), liver (1), colon (1), endometrium (1) 2 2
screening Follow-up 9 Bladder (1), kidney (1), lymphoma (1), 2 7
polycythemia (1), lung (2), uterus and breast (1),
pancreas (1), prostate (1)
Notes: *Cancers in stages I and II; **Cancers in stages III and IV.
Abbreviations: NA: Not available; PET/CT: Positron emission tomography/computed tomography.

The mean age of participants was 63 years, and 60% were of tumor markers (including carcinoembryonic antigen,
female. Four studies used CT for screening, 20-23 while two alpha-fetoprotein, CA19.9, CA125, and PSA for males),
used PET/CT. 24,25 Among these, the study conducted by chest radiography, and abdominal/pelvic ultrasound
23
Van Doormaal et al. compared extensive screening against examinations. The initial screening detected occult
limited tests. The other studies focused on evaluating the cancer in five patients (4.7%), and four additional cases
efficacy of a comprehensive screening. 20-22,24,25 (Table 4). were identified during the follow-up period. The overall
The study conducted by Jara-Palomares et al. enrolled sensitivity of the screening was 55.5%. Unprovoked PE and
20
107 patients with PE, who underwent an occult cancer a shock index of ≥1 variable were independent risk factors
screening program followed by a 2-year follow-up. The mean for occult cancer. Among patients diagnosed with cancer,
age of the participants was 63 years, comprising 56 females. 44.4% (4 out of 9 patients) died due to cancer.
The cancer screening program included a comprehensive Another study enrolled 51 patients with a mean age of
21
medical history review, physical examination, routine 55 years (range: 27 – 84 years), 31% of whom were female
blood chemistry, complete blood count, determination The screening protocol comprised a thorough medical

Volume 11 Issue 4 (2025) 10 doi: 10.36922/jctr.24.00069