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A Nickel's Worth of Cancer

Deborah L. Ornstein, MD
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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
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“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).

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