DIAGNOSIS OF CANCER-ASSOCIATED VASCULAR DISORDERS

BACKGROUND. Unexplained thromboembolism may be an early indicator of t he presence of a malignant tumor before signs and symptoms of the tumo r itself become obvious. METHODS. A survey of the MEDLINE data-base wa s conducted concerning cancer-associated vascular disorders and their role in the diagnosis of hidden cancer. The spectrum of vascular disor ders hearalding occult cancer and the associated laboratory abnormalit ies were scrutinized. RESULTS. Deep venous thrombosis was associated w ith a significantly higher frequency of malignancy during the first 6 months after diagnosis. Malignancies were found using simple clinical and diagnostic methods; additional screening was not cost-efficient. O ther signs associated with deep venous thrombosis that increased the p robability of an occult cancer were age older than 50 years, multiple sites of venous thrombosis, associated venous and arterial thromboembo lism, thromboembolism resistant to warfarin therapy, and paraneoplasti c syndrome. Among vascular syndromes, only cutaneous leukocytoclastic vasculitis presenting after the age of 50 years was consistently assoc iated with cancer. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role as a tumo r marker. The sensitivity for all samples analyzed from cancer patient s was 80% and the specificity was 83%. CONCLUSIONS. Data from the lite rature enabled us to outline clinical clues that might distinguish pat ients with cancer-associated vasculopathies from those unaffected by m alignancies. Preliminary data with an antigen specific to tumor tissue , the cancer procoagulant, suggested its possible role in detecting ea rly stage cancer. However, large-scale prospective studies are not cur rently available to evaluate the role of these clues and laboratory as says in the diagnosis of early stage cancer. (C) 1996 American Cancer Society.