Carcinoma and Venous Thrombosis: the Frequency of Association of Carcinoma in the Body or Tail of the Pancreas with Multiple Venous Thrombosis

Text-books of medicine and of pathology often refer to the coincidence of a malignant tumor of epithelial origin and venous thrombosis. One of the earliest observers to stress this relationship was Trousseau (1) in 1865. He was especially interested in the frequency with which thrombosis of one or more peripheral veins was the first indication of the presence of a malignant tumor. Since his series of patients included those with tumors arising in the stomach, uterus, and testis, he concluded that the tendency to thrombosis was a characteristic of carcinoma in general and not dependent upon its origin in any particular organ. Recently Thomson @) quoted extensively from Trousseau's original article and added a description of three cases in which the presenting disability was thrombosis of the veins of the leg. Examination after death showed a carcinoma arising in the tail of the pancreas in one of the patients, and of uncertain origin in another, A tumor of the stomach wall was demonstrated by x-ray studies in the third. Again emphasis was placed on the absence of any sign of internal disorder when the venous thrombosis was first apparent. In citing somewhat similar cases, James and Matheson (3) regarded thrombosis as an incident of the advanced stages of'a variety of debilitating diseases such as chronic infections, anemias, and malignant. tumors. They describe two cases of carcinoma of the stomach in which there was occlusion of the basilic and saphenous veins respectively and a carcinoma of the lung associated with multiple thrombosis oL internal and peripheral veins. Such individual cases, while of value, give no indication of a significant relationship. I t was of interest, therefore, to note that an analysis by Barker (4) of the non-infectious systemic diseases complicated by thrombosis at the Mayo Clinic revealed the presenceof a carcinoma in 27 of the 58 cases included in this group. This report was based on clinical observation alone, necessitating limitation of the study to thrombosis of the veins of the legs and occasionally of the upper extremities. A similar study, based on necropsy reports, of causative factors involved in intru vitum coagulation of the blood was presented by Haward (5). In a series of 2,903 necropsies, fatal thrombosis had occurred in 81. A list of the underlying diseases in these cases placed cancer second in frequency, exceeded only by middle ear infection. Further indication that a relationship may exist between cancer and coagulation of the blood was found in the numerous reports of changes in bleeding and coagulation time in the presence of a carcinoma. Figurelli (6) reviewed