Blood clots are a very serious health concern for uterine cancer patients. Unfortunately, blood clots can form at any time and sometimes come out of nowhere. In this post, I will delve into the connection between blood clots and uterine cancer and explain underlying causes, symptoms and tests and most importantly, natural ways to reduce your risk.
WHAT ARE BLOOD CLOTS AND HOW DO THEY FORM?
A blood clot is a semi-solid mass of blood that forms when platelets, proteins and other cells stick together.
Coagulation, also called the clotting cascade, is a complex series of biochemical reactions that transforms liquid blood into a solid clot. It involves 12 different clotting factors, certain proteins in the blood, platelets, ionized calcium and phospholipids that all activate and interact with each other in a very specific sequence. Think of it like a pipe with water (blood) flowing through it at a construction site that springs a leak (injury). All these factors and proteins are like the construction crew that rush to the site and help one another to fix the leak by building a plug.
The process of blood clotting is essential for stopping bleeding when an injury occurs. However, when blood clots form inappropriately within blood vessels, they can obstruct blood flow leading to serious complications.
Endothelial cells that line the blood vessels normally prevent this activation so clots do not form in the vessel itself. There are three main factors that disrupt this balance and lead to clot formation inside a blood vessel. This is often described as Virchow’s triad. The three factors are:
- Endothelial injury – damage to the inner lining of blood vessels
- Hypercoagulability – an increased tendency of the blood to clot (thick, sticky blood)
- Stasis – the slowing or stagnation of blood flow
TERMINOLOGY OF BLOOD CLOTS
Thrombus
This is the medical term for a blood clot
Embolism
This is when the clot itself or a part of it travels somewhere else and gets stuck, causing a blockage
Venous Thromboembolism (VTE)
This is when a blood clot forms in a vein. It encompasses two blood clots of major concern. The clot can either stay in the vein, which is called a deep vein thrombosis, or travel to the lungs, which is called a pulmonary embolism.
Deep Vein Thrombosis (DVT)
These clots form in deep veins, usually in the legs, but other areas as well. They can cause pain, swelling, redness and warmth. The most significant danger of a DVT is that a piece of the clot can break off and travel through the bloodstream to the lungs.
Pulmonary Embolism (PE)
This occurs when a blood clot lodges in the arteries of the lungs. A PE is a life-threatening condition with symptoms of shortness of breath, chest pain, rapid heart rate, feeling light-headed and coughing up blood.
HOW UTERINE CANCER INCREASES THE RISK OF BLOOD CLOTS
Women with uterine cancer have a higher risk of developing blood clots. The incidence has been reported as anywhere between 0.8 – 8.1% but up to 20% of cancer patients may develop a blood clot at some point. Unfortunately, VTE is associated with worse outcomes and is a common complication of major pelvic and abdominal surgery. Here are some reasons why blood clots are more prevalent in uterine cancer patients.
THE CANCER ITSELF
Cancer often leads to thick, sticky blood because the cancer cells produce and release pro-coagulant factors that activate the clotting cascade. Cancer cells can interact with platelets and other blood components to create a protective shield around themselves, which not only aids in evading the immune system, but also promotes clotting. This hyperocoagulable state is further exacerbated by the inflammatory environment associated with cancer, which increases the production of fibrinogen and other clotting factors.
RADICAL HYSTERECTOMY
Major pelvic and abdominal surgeries are a known risk factor for forming blood clots. Firstly, the surgery itself is a significant stressor on the body and can trigger an inflammatory response, which may enhance coagulation activity. Secondly, during and after surgery, patients are often immobile for long periods of time, which can lead to blood pooling and stasis, particularly in the legs. Thirdly, manipulation of the tissues and blood vessels during surgery can cause endothelial damage. All of these factors combined create a hypercoagulable state, increasing the risk of developing blood clots after surgery.
CANCER TREATMENTS
- Chemotherapy drugs can lead to a hypercoagulable state through various mechanisms including: damaging the endothelium and triggering the coagulation cascade; increasing levels of pro-coagulant factors and reducing natural anti-coagulants; increasing platelet count, platelet activation and aggregation making it easier for clots to form. Chemotherapy can make the blood viscous, which slows blood flow, increasing the risk of stasis. The potent drugs cause rapid breakdown of cancer cells, releasing thrombogenic substances into the bloodstream. The placement of a port catheter for drug administration can damage blood vessel walls and create inflammation. In addition, chemotherapy can lead to prolonged periods of immobility due to nausea and fatigue.
- Radiation therapy can damage endothelial cells lining the blood vessels in the treated area. It increases the expression of adhesion molecules on endothelial cells. This makes it easier for platelets and white blood cells to stick to the vessel wall and initiate clot formation. Over time, radiation can cause scarring and narrowing of blood vessels in the treated area, impeding blood flow. Radiation for uterine cancer often involves the pelvis where major veins are located. Damage to these vessels can increase the risk of deep vein thrombosis in the legs and pelvis.
- Hormone therapies, particularly Avastin, block vascular endothelial growth factor (VEGF), which is crucial for the formation of new blood vessels. By blocking VEGF, Avastin can impede the repair of damaged blood vessels, potentially leading to clot formation. Avastin frequently causes high blood pressure, which can damage blood vessel walls. Some studies suggest anti-VEGF therapies may have direct effects on the coagulation system, potentially increasing levels of pro-coagulant factors and decreasing anti-coagulant factors. Avastin can cause proteinuria (protein in the urine) and nephrotic syndrome (kidney disease leading to protein loss in the urine). These conditions are often associated with a hypercoagulable state.
OTHER RISK FACTORS FOR BLOOD CLOTS
- Smoking
- Obesity
- Covid-19
- Diabetes
- Sitting or laying in one position for a long period of time (long plane flights, surgery recovery)
We are never really out of the woods when it comes to increased risk for blood clots after a cancer diagnosis. I know women who developed blood clots years after treatments were finished. It is very important to be aware of this problem and take measures to prevent clots from forming or get help immediately if you have any suspicious symptoms.
TESTS FOR BLOOD CLOTS
D-DIMER
Normal Range: < 0.5 µg/mL FEU (fibrinogen equivalent units)
- After a blood clot is formed and no longer needed, an enzyme called plasmin breaks down the fibrin in the clot. This breakdown process generates various fibrin degradation products, one of which is D-dimer. Normally there are very low or undetectable levels of D-dimer in the blood. However, if there is significant blood clot formation and breakdown occurring, the D-dimer levels will be elevated.
- The D-dimer test is primarily used to rule-out the presence of a blood clot. If D-dimer levels are low, it is very unlikely you have a blood clot.
- A high D-dimer level indicates there is some abnormal clotting and breakdown occurring and the blood is becoming thick and sticky. However, this test is not specific for blood clots. Other causes for elevations include recent trauma or surgery, infection, cancer, liver disease, inflammation and more. Depending on the circumstances, further testing may be required.
- Elevated D-dimer levels can indicate a higher risk of thrombotic events, which are common complications in cancer patients. Not only that, but thick, sticky blood is often associated with cancer progression and metastasis.
FIBRINOGEN
Normal Range: 250-350 mg/dL
- Fibrinogen is a clotting factor produced by the liver that plays a crucial role in the clotting cascade. Fibrinogen is converted to fibrin and fibrin forms the structural meshwork of the blood clot.
- High fibrinogen levels can make a person more susceptible to clotting, which not only poses a risk for cardiovascular events (heart attack, stroke), but also fuels cancer growth. Fibrinogen is an acute-phase reactant, meaning its levels increase during inflammation, infection, trauma or certain diseases like cancer. Checking fibrinogen levels helps evaluate the risk of hyper-coagulation and chronic systemic inflammation, both of which can contribute to cancer progression and metastasis.
You should ask your doctors to monitor these two blood tests regularly even if you do not have any symptoms of a blood clot. These tests can help you know if your blood is becoming thick and sticky and can be an early indicator of inflammation or cancer recurrence.
If doctors suspect you have a blood clot based on symptoms and blood tests, they will do imaging. The different forms of imaging include:
DUPLEX ULTRASOUND
This is a non-invasive very accurate test using sound waves to diagnose deep vein thromboses, mainly in the legs.
CT ANGIOGRAM
This is a special CT scan with contrast for diagnosing pulmonary embolisms or blood clots in arteries and veins of the legs, abdomen or pelvis.
MRI ANGIOGRAM
Instead of a CT, doctors use MRI and a different contrast agent.
There are other blood tests and imaging tests, but these are the main ones.
NATURAL WAYS TO PREVENT BLOOD CLOTS
FISH OIL
Fish oil is an excellent supplement to prevent blood clots from forming and has many other benefits for uterine cancer patients. Fish oil reduces platelet clumping. It also reduces blood viscosity and promotes blood vessel dilation leading to improved blood flow. Fish oil lowers pro-coagulant factors like fibrinogen, thrombin and factor V and increases anti-coagulant factors. It makes red blood cells more flexible so they can travel through small blood vessels easily, reducing the risk of stagnant blood flow in the extremities. Fish oil is such a potent anti-coagulant that doctors will tell you to stop taking it for several days before a surgical procedure.
Dose: 2000 – 4000mg per day. Best if taken with food.
SERRAPEPTASE
Serrapeptase is a natural enzyme isolated from the silkworm intestine that breaks down proteins. It dissolves blood clots by breaking down fibrin and other dead or damaged tissue. It thins the blood and reduces the risk for thrombophlebitis (inflammation in a vein caused by a blood clot). Serrapeptase has many other benefits. It is anti-inflammatory, a good pain-reliever and reduces swelling. Serrapeptase stops bacteria from forming biofilms, thereby preventing resistant infections and has also been known to dissolve atherosclerotic plaques. Serrapeptase is proven effective in the treatment of Covid-19, which is a known risk factor for forming blood clots.
Dose: 20,000 – 120,000 SPU (10mg – 60mg) per day. Get an enteric coated form for better absorption and take on an empty stomach.
NATTOKINASE
Nattokinase is a potent fibrinolytic enzyme derived from natto, a Japanese food made from fermented soybeans. It directly breaks down fibrin and also enhances the body’s natural production of plasmin, the enzyme that dissolves blood clots. Like serrapeptase, it thins the blood and helps improve blood flow and circulation. Nattokinase is often used as a dietary supplement for preventing blood clots and supporting cardiovascular health.
Dose: 2,000- 7,000 Fibrinolytic Units (FU) once daily (100mg – 350mg). One study showed a dose of 10,800 FU/day (~500mg) was effective in managing atherosclerosis and hyperlipidemia.
VITAMIN E
A specific metabolite of vitamin E has known anti-coagulant properties. By down regulating certain receptors on platelets, vitamin E decreases the ability of platelets to clump together. It also interferes with signaling pathways involved in platelet activation and aggregation. Vitamin E inhibits an enzyme that is essential for the production and activation of several clotting factors in the coagulation cascade. It reduces the production of thromboxane, which is a prostaglandin that promotes platelet aggregation and vasoconstriction (narrowing of blood vessels). Vitamin E is a potent anti-oxidant and very beneficial for cancer patients.
Dose: The dose varies so it’s best to ask your naturopathic doctor what he/she recommends for you
SPICES
Turmeric (curcumin), ginger and garlic all have various bioactive compounds that have mild anti-coagulant effects. They also have tremendous healing benefits and should be a part of your meals whenever possible.
COMPRESSION SOCKS
Compression socks are specially designed to apply pressure to your legs, primarily at the ankle and gradually decreasing as they go up the leg. This compression narrows the veins and encourages blood to move up towards the heart, counteracting the effects of gravity, which causes blood to pool in the lower legs and feet. They improve lymphatic drainage and reduce swelling of the legs, feet and ankles. Veins have valves in them. The pressure from the socks helps the valves function better, preventing back flow of blood.
The degree of compression varies and is important. Compression is measured in millimeters of mercury (mm Hg).
- For tired achy legs, minor swelling and prevention during travel, over-the-counter compression socks of 8-20mm Hg are good.
- For varicose veins, moderate swelling or DVT prevention, compression of 20-30mm Hg may be necessary.
- Firm and extra-firm compression (30-40+mm Hg) is used for severe swelling, lymphedema or very large varicose veins and requires a prescription.
Make sure to have the correct fit. They should not be severely tight and restrict circulation. Apply them smoothly to avoid wrinkles or folds, which can create pressure points. The top band of the knee-high socks should sit just below the knee. Thigh-high socks should be positioned as directed, usually ending on the upper thigh. Never roll down the top of the socks as this can create a tourniquet effect.
Compression socks should be put on first thing in the morning, worn throughout the day, then removed in the evening. They are not just for travel. I often use these for days I will be on my feet a lot or if my feet and legs ache. If you know you will be immobile for a long period of time, you should consider wearing them. These are great for women who have desk jobs and sit most of the day and anyone who has diabetes.
EXERCISE
Exercise promotes good circulation thereby preventing blood clots. If you are sitting for long periods of time, here are some specific exercises that help a lot.
- ANKLE PUMPS
With feet flat on floor raise your toes as high as you can, keeping your heels on the ground. Hold for a few seconds. Lower your toes and lift your heels as high as you can, keeping the balls of your feet on the floor. Repeat this pumping motion rhythmically for 10-15 repetitions every hour.
- ANKLE CIRCLES
Lift feet slightly off the floor and circle ankles clockwise for 10-15 repetitions, then counter-clockwise every hour.
- KNEE LIFTS
With feet flat on the floor, lift one knee towards your chest, hold for a few seconds, then lower and repeat with the other leg. Do 10-15 repetitions every hour.
- LEG EXTENSIONS
If space allows do alternating leg extensions 10-15 repetitions every hour.
Getting up and walking, marching or stretching regularly is very beneficial.
Talk to your doctor before using supplements to reduce your risk for blood clots. If you are having a surgical or dental procedure you may need to stop the use of certain supplements several days before the procedure. If you are having any symptoms of a DVT or PE, get to the hospital right away to be checked, don’t wait!
You open Your hand and satisfy the desires of every living thing. Psalm 145:16