Patients who develop pulmonary emboli (PE) or who have so-called deep vein thrombosis (DVT), or both called venous thromboembolism (VTE), may have these problems due to an underlying cancer. The clotting problems may be the ﬁ rst sign of the underlying cancer. People do get clotting problems without any cancer and knowing who to subject to further testing and analysis is often a problem. We could not test all patients with clotting issues and many can be explained at the beginning, such as a recent surgery or a long plane ride.
Researchers have tried to develop a “risk score” to help identify those who need further testing and those who do not. By observing over 5,000 patients, a crude risk score has been suggested. Those patients with high risk scores should be evaluated for possible occult cancers. In men, the most common cancers to screen for are lung cancer, colorectal cancer and prostate cancer. Fortunately, each of these has some speciﬁ c screening test which can help determine if the patient with VTE has one of these underlying cancers. In women, breast cancer, colorectal cancer and uterine cancer were the top three. Once again, these cancers have well established screening procedures. Should you have what we refer to as an unprovoked clotting problem, i.e. one that has no obvious cause, and you have certain risk factors, especially older patients, you may need further assessment to be sure that your clot is not the harbinger of a more serious disease