Evidence-based case review - Should we look further for cancer in a patient with venous thromboembolism?

A 71-year-old woman with venous thromboembolism was referred to us to deter mine whether a workup for cancer was indicated. She had been hospitalized b ecause of deep venous thrombosis of her left leg and pulmonary embolism; sh e had no history of venous thromboembolism or cancer. For the past few mont hs, she had the feeling of being "full" before she had eaten much but had n o other constitutional or gastrointestinal symptoms. On physical examinatio n, she was found to be obese (body mass index*=33), and there was fibrocyst ic nodularity in both breasts. She also had a trace of symmetric edema in h er ankles. Laboratory test values showed mild normocytic anemia, but routin e chemistry test results were normal, as were those of her liver function t ests, urinalysis, activated protein C resistance, proteins C and S and anti thrombin III concentrations, antiphospholipid antibody, and a chest film.