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Tuesday 26 July 2016


Blood clot patients to receive routine cancer checks

Tens of thousands of people with deep vein blood clots will be checked for cancer every year under new NHS guidelines, after evidence emerged the blockages could be an early warning sign of tumours.

Deep vein blood clots, known as VTEs, can be symptomatic of cancer.
Deep vein blood clots, known as VTEs, can be symptomatic of cancer. Photo: Alamy

Every year about 4,000 people are found to have cancer after being hospitalised with deep vein blood clots.

However, cancer is usually only picked up many months later - usually for unrelated reasons - during which time it may have spread and become incurable.

Now experts say there is strong evidence that such clots can be an early warning sign of cancer, prompting the National Institute for Health and Clinical Excellence (Nice) to publish new guidance today urging doctors to run immediate cancer tests on patients with them.

The guidance will apply to up to 56,000 people diagnosed every year with either a deep vein thrombosis (DVT) or its more deadly variant, a pulmonary embolism (PE).

Dr Roshan Agarwal, a consultant oncologist at Hammersmith Hospital in London, said seven to 10 per cent of people with the clots were later diagnosed with cancer.

This was such a high frequency that clots should be considered a possible symptom of cancer, he said.

Screening them would typically mean cancer being diagnosed six months to a year earlier, he said, meaning more would be picked up while still curable.

“For a long time we have thought of cancer and blood clots as separate diseases,” he said. “They are not.”

He explained that certain cancers produced proteins that made the blood more sticky and likely to clot. Others pressed on vital blood vessels, making a blockage there more likely.

The cancer checks will include a physical examination, blood and urine tests and a chest x-ray.

In addition, those over 40 should be considered for a CT scan of the lower abdomen, to pick up a range of cancers such as gynaecological and bowel tumours, while women over 40 should also be offered a mammogram.

Dr Agarwal said many patients were only diagnosed with cancer “six months or a year” after being found to have the clots, collectively known as venous thromboembolisms (VTEs).

“During that time the cancer could have spread and no longer be curative,” he said.

At the moment there was little understanding, even among doctors, that clots could be symptomatic of cancer, he added, so the cancer was usually identified for a totally different reason.

“I'm a gynaecological cancer specialist, and I haven't had a single patient referred to me as a result of having a blood clot in five years,” he noted.

Another key aim of the guidance is to speed diagnosis of DVT and PE after onset of potential symptoms. A 2005 report estimated they killed 25,000 a year and many deaths were preventable.

DVT is when a blood clot becomes lodged in a deep vein, usually in the leg; while a PE occurs when such a clot gets flushed along and then becomes stuck in a lung blood vessel. A big enough clot in the lung can block blood flow so seriously it can kill.

Nice wants all hospitals to be able to diagnose VTEs within four hours of symptoms, so patients can be given blood thinners as soon as possible, if appropriate.

Professor Gerard Stansby, a Newcastle-based vascular surgeon, who chaired the guidance development group, said: “If you have an undiagnosed pulmonary embolism, the first few hours are very important because there's a higher death rate.”

He said there was widespread variation between hospitals’ ability to diagnose within four hours - and admitted it would be “a challenge” for many.

Some patients have to wait until Monday morning for a test if they came in on a Friday night.

He said: “In a modern environment I think it's appropriate for patients to get these tests seven days a week, and they are not just restricted to weekdays.”

He believed, if implemented, the changes would save many lives.

However, he conceded the guidance was not mandatory and at present it was not backed up with the threat of financial penalties for hospital trusts.

The guidance also aims to ensure that VTE patients with cancer are given a stronger type of blood-thinner to minimise their chances of developing another clot, because they are at a higher risk of doing so.

Simon Burns, the Health Minister, said: “Already the NHS has dramatically increased screening for VTE from around just 50 per cent in September 2010 to a world first of 90 per cent by December 2011, leading to better treatment and outcomes for patients suffering this serious and frightening condition.

"However despite this improvement we know more can be done in reducing the variation in VTE treatment.

"We expect the NHS to reduce this variation by following this NICE guidance.

"VTE may have a number of different causes, which means that clinicians treating VTE patients have an excellent opportunity to identify other health problems at an early stage.

"I hope that encouraging clinicians to link VTE and cancer will lead to improvements in the diagnosis of both diseases.”


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