Clinical Manifestations Patients with cancer who develop deep venous thrombosis usually develop swelling or pain in the leg, and physical examination reveals tenderness, warmth, and redness. Patients who present with pulmonary embolism develop dyspnea, chest pain, and syncope, and physical examination shows tachycardia, cyanosis, and hypotension. Some 5% of patients with no history of cancer who have a diagnosis of deep venous thrombosis or pulmonary embolism will have a diagnosis of cancer within 1 year. The most common cancers associated with thromboembolic episodes include lung, pancreatic, gastrointestinal, breast, ovarian, and genitourinary cancers, lymphomas, and brain tumors. Patients with cancer. | Chapter 096. Paraneoplastic Syndromes Endocrinologic Hematologic Part 9 Clinical Manifestations Patients with cancer who develop deep venous thrombosis usually develop swelling or pain in the leg and physical examination reveals tenderness warmth and redness. Patients who present with pulmonary embolism develop dyspnea chest pain and syncope and physical examination shows tachycardia cyanosis and hypotension. Some 5 of patients with no history of cancer who have a diagnosis of deep venous thrombosis or pulmonary embolism will have a diagnosis of cancer within 1 year. The most common cancers associated with thromboembolic episodes include lung pancreatic gastrointestinal breast ovarian and genitourinary cancers lymphomas and brain tumors. Patients with cancer who undergo surgical procedures requiring general anesthesia have a 2030 risk of deep venous thrombosis. Diagnosis The diagnosis of deep venous thrombosis in patients with cancer is made by impedance plethysmography or bilateral compression ultrasonography of the leg veins. Patients with a noncompressible venous segment have deep venous thrombosis. If compression ultrasonography is normal and a high clinical suspicion exists for deep venous thrombosis venography should be done to look for a luminal filling defect. Elevation of D-dimer is not as predictive of deep venous thrombosis in patients with cancer as it is in patients without cancer. Patients with symptoms and signs suggesting a pulmonary embolism should be evaluated with a chest radiograph electrocardiogram arterial blood gas analysis and ventilation-perfusion scan. Patients with mismatched segmental perfusion defects have a pulmonary embolus. Patients with equivocal ventilationperfusion findings should be evaluated as described above for deep venous thrombosis in their legs. If deep venous thrombosis is detected they should be anticoagulated. If deep venous thrombosis is not detected they should be considered for a pulmonary angiogram. Patients without
