Рак и тромб = паранепоастичний тромбоз

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Thrombosis is a condition in which a clot (thrombus) forms inside a blood vessel, which interferes with the normal movement of blood. Patients with malignant neoplasms may develop a complication associated with the development of thrombosis. If blood clots appear not due to trauma or other known causes, but as a result of the influence of a malignant tumor on the body, such a condition has a special name - paraneoplastic thrombosis.

Why is this topic important?

Oncology is a well-known and well-studied risk factor for thrombosis. The tumor has the ability to activate the blood clotting system, which is why the risk of thrombosis increases 7-28 times, reaching a maximum in the first 3-6 months after diagnosis. Factors related to the disease itself, such as the localization and histological type of the tumor, the stage of the disease, and the time since diagnosis, also significantly affect the blood clotting system. Characteristic is the high risk of thrombosis recurrence: more than 20% of patients have a repeated episode of thrombosis within the next year. Elderly age (>65 years), female gender, presence of concomitant diseases or pathologies, venous thromboembolism in history, significantly increase the risk of thrombosis.

Why is a tumor a risk of thrombosis and is it the other way around?

Even in the absence of clinical manifestations, cancer patients are at increased risk of thrombosis (subclinical hypercoagulability). This is because about 5% of patients are diagnosed with oncology after a case of thrombosis, which confirms the direct effect of the tumor on the blood coagulation system, and the complication itself is facilitated by specific treatment, staged, highly traumatic surgical interventions, radiation, chemotherapy, which, by the way, increases the risk of thrombosis by 200%. During the formation of a blood clot, factors and proteins are activated that ensure blood clotting and contribute to the growth of a malignant tumor and the progression of the disease. It is also important to consider that the genetic mechanisms that lead to oncological transformation directly affect the expression of genes responsible for maintaining hemostasis.

Symptoms to look out for
Depending on which vessels the thrombus is located, different symptoms may occur:

In the legs (signs of deep venous thrombosis):

Sudden swelling of one or both legs;
Pain or a feeling of heaviness that increases when walking or standing;
Redness or blueness of the skin;
Local increase in temperature (the limb is warmer to the touch).
In the lungs (signs of pulmonary embolism):

Sudden shortness of breath;
Chest pain that increases with deep breathing;
Rapid heartbeat, weakness, dizziness;
Sudden cough, sometimes with blood.
In the vessels where the catheter is installed:

Swelling and pain in the arm or shoulder
Redness along the vessel or around the catheter

How to prevent paraneoplastic thrombosis?
Be active. If possible, do light exercise, move more, even short walks help. When bedridden, try to move your feet, move your legs in bed.
Drink enough fluids. Water makes the blood less thick. Try to drink regularly throughout the day (unless your doctor has restricted fluids due to other illnesses).
Control your weight and diet. A balanced diet with vegetables, fruits, and protein helps keep your vessels in better condition.
Do not sit or lie in one position for a long time. When traveling or sitting for a long time, try to stretch your legs every 1–2 hours.
Add compression hosiery to your daily routine (as prescribed by your doctor). Compression underwear improves blood circulation in the legs and reduces the risk of clots.
Take the medications prescribed by your doctor. If your oncologist, hematologist, or vascular surgeon has prescribed special drugs to prevent thrombosis (injections or pills), take them regularly and do not skip them.
Pay attention to the symptoms. Swelling, pain in the leg or arm, shortness of breath, chest pain are a reason to urgently consult a doctor.

Preventive and treatment recommendations:
Preventive examinations by an angiosurgeon. Vascular ultrasound.
Blood test monitoring. Increased D-dimer levels, thrombocytosis, leukocytosis, low hemoglobin levels are the main markers for determining the risk of thrombosis in cancer patients;
CT and MRI observations to monitor the course of cancer and assess the condition of the vessels;
Pharmacological therapy most often includes drugs (anticoagulants) to thin the blood or dissolve an existing blood clot. In cancer patients, anticoagulant prophylaxis should be carried out both during and after treatment under the control of laboratory tests, risk assessment and only as prescribed by a doctor.
Implantation of a cava filter in case of frequent thrombosis recurrences.
Comprehensive and regular monitoring by oncologists to identify early risks of thrombosis.

What does a cancer patient need to know?
In the case of outpatient chemotherapy courses, it is recommended to conduct an assessment of the risk of thrombosis.
All hospitalized patients who receive drug treatment for malignant neoplasms and do not have a high risk of bleeding are shown prophylaxis

Автор: Фесянова Лилия Ивановна MD ©