Diagnostic Approach for Pulmonary Embolism on Solid Cancer Patients: A Case Series

Abstract

Solid cancer patients have higher risk to get Venous Thromboembolism (VTE) compared to normal population, particularly on solid cancer patients with histopathology type of adenocarcinoma, advanced stage, cancer treatment, and immobilized. VTE can be in the form of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE). PE incident in cancer patients resulted in high mortality between 30 to 80% and often not properly diagnosed because 81% of the cases did not show any symptoms. This is a serial case from six cancer patients who were diagnosed with PE. According to the Revised Geneva Score, three patients were in the category of high risk, and three patients were in moderate risk of PE. All six patients had elevated D-dimer value, and therefore, according to the algorithm from the International SocietyonThrombosisand Hemostasis (ISTH) in 2017, the confirmation of PE diagnosis is to be done by performing gold standard imaging test, where perfusion lung scan is considered one of it. All six patients had the type of cancer histopathology of adenocarcinoma, with advanced stage, had various VTE risk factors, and showed symptoms, such as shortness of breath, pleuritic chest pain, swelling on extremity, and hemoptysis. Patients who were diagnosed with PE received anticoagulant treatment according to the standard therapy. Vigilance must be exercised if PE is suspected, particularly in cancer patients with high or moderate Revised Geneva Score. It is expected that screening will lead to adequate management which then result on the reduction of mortality due to PE.