The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

A Nickel's Worth of Cancer

Deborah L. Ornstein, MD
[+] Article, Author, and Disclosure Information

From Yale University School of Medicine, New Haven, CT 06520-8070.

Potential Financial Conflicts of Interest: None disclosed.

Request for Single Reprints: Deborah L. Ornstein, MD, Department of Pathology, Yale University School of Medicine, PO Box 208070, New Haven, CT 06520-8070.

Ann Intern Med. 2008;149(5):350-352. doi:10.7326/0003-4819-149-5-200809020-00010
Text Size: A A A

“A nickel's worth of cancer can give a dollar's worth of  clot.” My mentor, Dr. Leo Zacharski, is fond of using this expression to describe the phenomenon of clinically overt venous thromboembolism (VTE) triggered by clinically occult cases of cancer. Although Armand Trousseau first described the association between cancer and thrombosis (1) and later developed cancer-associated thrombosis himself, it was Illtyd James and Matheson (2) who in 1935 first promulgated the idea that clinically inapparent cancer could trigger thrombosis. They reported on a seemingly cancer-free patient who developed symptomatic cancer 2 months after presentation with thrombosis and made the conjecture that cancer was already present and that the tumor cells activated the thrombotic process (2). We now recognize that it takes only a small number of cancer cells with a procoagulant phenotype to initiate coagulation reactions that host coagulation proteins then amplify to produce massive clots (35). Indeed, compared with the general population, patients with VTE are at substantially increased risk for harboring or subsequently developing cancer (6).

First Page Preview

View Large
First page PDF preview





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.