Screening for Occult Cancer in Patients with Venous Thromboembolism

Unprovoked venous thromboembolism (VTE) can be the first sign of an occult cancer. The rate of occult cancer detection within 12 months of a newly diagnosed unprovoked VTE is approximately 5%. Therefore, it is appealing for clinicians to screen patients with unprovoked VTE for occult cancer, as it could potentially decrease cancer-related mortality and morbidity and improve quality of life. However, several randomized controlled trials have failed to report that an extensive occult cancer screening strategy (e.g., computed tomography of the abdomen/pelvis) is improving these patient-important outcomes. Therefore, clinical guidance documents suggest that patients should only undergo a limited screening strategy including a thorough medical history, physical examination, basic laboratory investigations (i.e., complete blood count and liver function tests), chest X-ray, as well as age- and gender-specific cancer screening (breast, cervical, colon and prostate). More intensive occult cancer screening including additional investigations is not routinely recommended. This narrative review will focus on the epidemiology, timing, and evidence regarding occult cancer detection in patients with unprovoked VTE.