The Cancer Clot Connection: A Patient Story

The word "cancer" is a frightening term for most of us and brings up all sorts of mental images and fears. In 2008, there were 1.4 million cases of cancer reported in the United States by the American Cancer Society. Of those, 11 percent of cancer patients will develop symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE).

While cancer is a scary thought, it pays to keep calm and become educated about the associated risks if you or your loved one has been diagnosed with cancer and is undergoing cancer treatment. DVT/PE is the second leading cause of death in those with cancer (cancer itself is the first).

DVT is the abnormal clotting of the blood in a deep vein and most commonly occurs in one or more veins of the leg or pelvis. PE occurs when a DVT breaks free from its original site in a vein and then travels through the bloodstream into the lungs. When an individual has cancer, it is thought that cancer cells may produce proteins that increase clotting and make a patient at greater risk for DVT/PE.

In 2006, "CeCe" learned the hard way about the connection between cancer and DVT. An active and dynamic woman, CeCe had a busy life and booming law practice. She was in the process of moving her office and spending a great deal of time on her feet when she noticed that her right leg had started to swell. She had broken her right foot the previous year and thought perhaps the problem with her leg was related to her prior injury. When the swelling spread to involve her knee, she sought medical advice.

The cardiologist who ordered an echocardiogram of the heart ruled out heart trouble as the cause of her swelling. Then the cardiologist looked for a blood clot and performed an ultrasound in the legs, which revealed a DVT and a large mass in her lymph nodes and right groin. A biopsy confirmed that she had a metastatic squamous cell carcinoma or cancer of the cervix. CeCe's leg was so swollen that, in her words, it looked like a condition known as "elephantiasis." She was given the blood-thinning medication heparin to treat the clot. In order to perform surgery to remove the mass a retrievable inferior vena cava filter (a filter which is placed in the inferior vena cava (IVC), which is the main vein in the abdomen and chest that connects to the heart. A filter is designed to trap clots that move up the vein before they can reach the lungs and cause a PE) was placed so that the surgeon could take her off the blood-thinning medications safely in preparation for surgery.

After a successful 10 hour operation, surgeons successfully removed the tumor. CeCe was up and walking within 24 hours and had her energy back. Once the IVC filter was removed and the blood thinners were restarted, she began chemotherapy and radiation treatment.

Even though cancer runs in my family, I think I have been very lucky," said CeCe. "I believe it was because I take such excellent care of myself through good nutrition that this all resolved so well. I am happy to help others and spread the word any way I can." After six months of blood-thinning therapy, CeCe was found to be cancer-and clotfree. She was then given a low dose of Coumadin¨ to prevent future clotting of the central venous line that she had placed for infusion of chemotherapy.

"It was the symptoms of DVT that led to the diagnosis of CeCe's malignancy," said Dr. Suman Rathbun of the University of Oklahoma and the Venous Disease Coalition. "The cancer in CeCe's case was caught early enough to allow her full recovery with treatment. Originally her oncologists were not optimistic about her survival since the cancer was already metastatic, but her positive attitude, self-education and perseverance prevailed."

Do not ignore the signs and symptoms of DVT and PE and seek care immediately for any of these symptoms:

Symptoms/Signs of Possible DVT:

• Recent swelling of one or both legs
• Unexplained pain or tenderness of one or both legs

• Recent or sudden shortness of breath
• Sharp chest pain, especially when breathing in
• Coughing up blood
• Sudden collapse