Clot-prediction system to minimise risk after cancer surgery
Posted on: 29 September 2020
Research at the Trinity St James’s Cancer Institute (TSJCI) is investigating the prevention of thrombosis in cancer patients after surgery. Cancer and its treatment are risk factors for thrombosis. Gynaecological cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. Thrombosis refers to abnormal, life-threatening blood clots that form in an artery or vein.
After a patient has surgery to treat gynaecological cancer, the risk of developing a blood clot is relatively high. If left untreated, such clots can be fatal. On average 10% of gynaecological patients will suffer a blood clot during their cancer treatment but it can be as high as 27% in certain types of ovarian cancer. Blood clots are the leading cause of death in cancer patients, after the cancer itself.
Patients are particularly at-risk following cancer surgery despite preventative treatment and their risk will depend on the type of gynaecological cancer they have and the extent of their surgery.
Blood clots can be prevented using drugs called heparins which are given in the form of a daily injection. Currently the guidelines suggest a “one size fits all” approach to this preventative treatment which means that all patients get the same treatment, regardless of their individual risk and the extent of their surgery.
Unfortunately, it is difficult to predict who is most likely to develop a clot, so every patient is put on preventative medication after cancer surgery. However, despite the medication, some people still develop clots.
Dr Lucy Norris, Senior Scientist at TSJCI, has analysed biobank blood and tumour samples from consenting patients undergoing surgery for gynaecological cancer. Dr Norris has identified clinical risk factors and proteins in the blood that help predict the clot risk in gynaecological cancer.
Using this system, she has developed and validated the Thrombogyn score; a scoring system that can predict patients at high and low risk of blood clots following their cancer surgery. Being able to easily predict the risk of clots before the patient has surgery will mean that clot prevention treatments can be tailored for that individual patient. Prevention will be more effective in high risk women, as a result and will reduce the need for unnecessary extended therapy for low-risk women.
Although, there are scoring systems already in existence internationally which are used in all cancer patients, they are not successful for gynaecological cancers, as they do not distinguish between high and low risk groups within the this particular cancer population, As a result, they are not used by gynaecological cancer surgeons.
The team’s scoring system is unique in combining clinical risk factors with blood clotting proteins in the blood to predict thrombosis in gynaecological cancers. Dr Norris is working with groups internationally to validate the scoring system to see if it is successful in other groups of gynaecological cancer patients.
Dr Norris said:
The treatment of cancer, be it surgery or chemotherapy, can often be as difficult for the patient as the cancer itself. Personalised therapies are more effective and have fewer side effects. The explosion in technology now allows scientists to understand how cancers occur however this type of technology is expensive and only by funding this type of science will we develop new treatments personalised to individual tumour types which will be more effective and have fewer side effects than those currently available.
Trinity St James’s Cancer Institute
The mission of the Trinity St James’s Cancer Institute is to integrate innovative and groundbreaking cancer science with compassionate multidisciplinary , patient focussed care, through translation of key research findings, into incremental advances in the prevention, diagnosis and treatment of cancer.