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Is there a link between strokes and cancer?

Some stroke survivors may have underlying cancer, according to an observational study to be presented at the ESMO 2017 Congress in Madrid.
“Post-mortem studies have suggested that cancer can develop after a stroke, but the magnitude of this association has not been described,” said lead author Dr Jacobo Rogado, medical oncology fellow, Hospital de La Princesa, Madrid, Spain. “We conducted a study that would allow us to establish whether this association actually exists and which factors may predict risk.”

A total of 381 patients met the inclusion criteria and were followed for 18 months from the diagnosis of stroke. Demographic and clinical data were collected and compared between those who did, and did not, develop cancer. Variables that were significantly associated with cancer in univariate analysis were then subjected to multivariate analysis.
During the 18-month follow-up, 29 (7.6 %) of stroke survivors were diagnosed with cancer, most frequently in the colon, lung and prostate. This was higher than the expected incidence of 17 patients (4.5 %), based on statistics for the general population.

The average time from stroke onset to cancer diagnosis was six months. Nearly 45 % of cancer diagnoses occurred within the first six months after a stroke diagnosis. Almost two-thirds (62 %) of cancer patients presented with metastatic or locally advanced disease.
Multivariate analysis revealed that older age, previous diagnosis of cancer, high levels of fibrinogen, and low levels of haemoglobin, were associated with cancer. This indicates that the cancer was already present when the stroke occurred.

“It has been suggested that cancer is a hypercoagulable state in which tumour cells activate the coagulation system,” said Rogado, “this could explain our observation of higher fibrinogen in those who were diagnosed with cancer. It may be that the prothrombotic effect of cancer contributed to the strokes.”

Commenting on the research for ESMO, Dr Fausto Roila, director of medical oncology, Santa Maria della Misericordia Hospital, Perugia, Italy, said, „The design of this study has an important limitation, which is the lack of a matched control group. Moreover, comparing the detected number of incident cases with those observed in a general population, the difference is only 12 patients and this could be due to differences in age between the two groups. Therefore, further studies are needed before a firm association can be established between stroke and cancer.”

Rogado J et al., abstract 1412P_PR: Ischemic stroke as cancer predecessor and associated predictors