Advanced cancer often presents patients with complex health challenges. Understanding potential complications is important. This article explores the relationship between advanced cancer and the occurrence of stroke.
Stroke Occurrence in Terminal Cancer
While not the most frequently discussed complication, stroke does occur with increased prevalence in terminal cancer patients compared to the general population. Data indicates that cancer patients face a risk of stroke that is approximately twice that of individuals without cancer. This elevated risk becomes particularly pronounced in the months following a cancer diagnosis, and it can also increase with longer follow-up times.
Around 1 in 10 ischemic stroke patients also have concurrent cancer. The incidence of fatal stroke among cancer patients is about 1.1%.
Underlying Connections
The elevated stroke risk in terminal cancer patients stems from several intertwined biological and physiological factors. A primary mechanism is hypercoagulability, which refers to an increased tendency for blood clotting. Tumor cells can activate platelets and generate thrombin, leading to a prothrombotic state that promotes clot formation. Certain cancer types, such as pancreatic, lung, and gastric cancers, are particularly associated with a higher risk of thromboembolism.
Inflammation also plays a role, as cancer often induces systemic inflammation that can contribute to atherosclerosis and thrombosis, both of which are underlying causes of stroke. Additionally, cachexia, a wasting syndrome common in advanced cancer, can be associated with systemic inflammation and may influence stroke risk. Cachexia involves significant loss of skeletal muscle and body fat, impacting overall health.
Cancer treatments, including chemotherapy and radiation therapy, can further increase stroke risk. Radiation, especially to the head, neck, or chest, can lead to scarring and thickening of arteries over time, potentially causing blockages. Chemotherapy agents can also enhance thrombin generation and contribute to a procoagulant state. Tumors may also directly compress blood vessels or contribute to paraneoplastic syndromes, where the immune system attacks healthy nervous system cells, potentially causing strokes.
Recognizing Stroke Signs
Identifying the signs of a stroke quickly is important, especially for patients with advanced cancer where prompt medical attention can minimize brain damage. A commonly used acronym to remember stroke symptoms is FAST.
The “F” stands for Face drooping, where one side of the face may appear to sag or feel numb. The “A” refers to Arm weakness, which can be identified if one arm drifts downward when both are raised. “S” signifies Speech difficulty, meaning the person might have slurred speech or trouble finding words. Finally, “T” means Time to call emergency services immediately if any of these signs are observed. Other potential signs include sudden confusion, trouble seeing, or a sudden, severe headache.
Addressing Stroke Risk in Advanced Cancer
Healthcare providers manage stroke risk in advanced cancer patients through various individualized strategies. Proactive monitoring for signs of hypercoagulability, such as elevated D-dimer levels, can help identify patients at higher risk. The use of anticoagulants, or blood thinners, is often considered to prevent blood clots, though the decision requires careful balancing of stroke prevention against the increased risk of bleeding in these patients.
Treatment decisions are highly personalized, taking into account the type and stage of cancer, overall health, and potential for bleeding complications. Low-molecular-weight heparin (LMWH) has traditionally been a preferred option for cancer-associated thrombosis, and newer direct oral anticoagulants (DOACs) are also being explored. Care plans emphasize managing all contributing factors, including controlling traditional cardiovascular risk factors like high blood pressure and cholesterol, and encouraging appropriate physical activity when possible.