I recently saw a patient from Poole in Dorset who came to see me after a deep vein thrombosis wondering whether he needed any tests. Well he was in his 60s so I had some unpalatable news for him — as his deep vein thrombosis was unprovoked he should have tests to check that he does not have cancer.
So what exactly do I mean by “unprovoked”? Well this is a deep vein thrombosis that comes apparently “out of the blue”. That means that in the preceding 3 months before the development of the deep vein thrombosis, there has been no evidence of major surgery or major trauma, there has been no immobility (the person has not been bedridden or has spent a significant part of the day either in bed or in a chair), the person is not pregnant and the person is not taking hormone replacement therapy or the oral contraceptive pill.
Now if a deep vein thrombosis is unprovoked and the person is under 40 years old, then they should have as a bare minimum a full examination, a chest x-ray, some screening blood tests and they should have their urine analysed. If the person is over the age of 40 and has an unprovoked deep vein thrombosis, then they should be fully investigated for cancer. And that means a mammogram in a woman and in both men and women a CT scan of the abdomen and pelvis. Now I don’t want to cause alarm but approximately 10% of people who have an unprovoked deep-vein thrombosis then find that they have a cancer within the next 12 months. Now they probably had the cancer at the time of the DVT, it’s only just become apparent with time. And we know if you diagnose cancer early you get better results. So screening people with an unprovoked deep vein thrombosis gives a really good opportunity to diagnose a cancer at an early stage when it might well be treatable, curable and perhaps be life-saving. Cancer can cause changes in the “stickiness” of the blood making it more likely to clot and this is why sometimes the first sign of cancer is a clot in the deep veins of the legs.
So please do not be alarmed but if you have had a deep vein thrombosis which has apparently come out of the blue, you ought to see your doctor. If you are over the age of 40 years, I think now it is probably best that you are referred to a haematologist in a hospital. He is a specialist who can assess your risks and perform the appropriate investigations. All of this should be available on the NHS.
Here is the link to the NICE guidance on this matter which came out a year ago and I hope you find it useful.
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If you’re worried about your veins and would like a confidential chat please do get in touch. I am happy to offer simple advice by telephone or email for free and without obligation.
The VeinCare Centre also offers a screening assessment with our vascular technologist. For £25 you can have a scan with Wendy Parsons. She is not a doctor and so she could not give you medical advice but she can check your deep veins and your varicose veins and give you an idea of how bad they are and what treatment options might be available. If you would like to have an appointment with Wendy please call 0800 698 3467.