Anna Werrett
Lung cancer is associated with an increased risk of stroke. A study by the National Cancer Institute found that within six months of a cancer diagnosis, the risk of having a stroke was more than twice that of people without cancer. People with lung cancer or more advanced cancers had the greatest excess risk of stroke.
The risk of stroke in lung cancer patients is due to a variety of factors, including hypercoagulability, non-bacterial thrombotic endocarditis, direct tumour compression of blood vessels, and treatment-related effects. Lung cancer patients with stroke have poorer clinical outcomes and longer hospital stays compared to stroke patients without cancer.
| Characteristics | Values |
|---|---|
| Risk factors | hypertension, atrial fibrillation, patent foramen ovale |
| Cancer types | lung, pancreatic, colorectal, breast, prostate |
| Cancer-associated treatments | radiation treatment, chemotherapy |
| Symptoms | facial droop, arm weakness, speech difficulty |
| Treatment | lowering cholesterol, echocardiogram, blood vessel imaging, controlling blood pressure, giving blood thinners |
What You'll Learn
Lung cancer and stroke: what are the risk factors?
A ministroke, or transient ischemic attack (TIA), is a temporary blockage of blood flow to the brain, caused by a blood clot. The effects of a ministroke are usually temporary and resolve within minutes or hours. However, ministrokes can be a warning sign of more severe and debilitating strokes.
The biggest risk factors for ministrokes are:
- Hypertension (high blood pressure)
- Atrial fibrillation (irregular heartbeat)
- Patent foramen ovale (PFO): a condition where the hole between the left and right sides of the heart in a developing fetus doesn't close completely after birth. Blood clots can cross over and go directly into the arteries that feed the brain.
Cancer patients may be at a higher risk of ministrokes due to the following factors:
- Cancer and some cancer treatments can change the properties of blood, making it thicker or "stickier". This can increase the likelihood of blood clots, which can lead to strokes or ministrokes.
- Cancer patients may be physically weak and have limited mobility, which can further increase the risk of blood clots.
Ministrokes are considered medical emergencies and require immediate attention. Treatment for ministrokes aims to:
- Minimise damage and prevent further complications
- Manage risk factors to prevent future ministrokes or strokes
- Depending on the type of stroke, treatments may include lowering cholesterol, performing imaging tests, monitoring heart rhythm, controlling blood pressure, and administering blood thinners.
There are two main types of strokes:
- Ischemic stroke: This is the most common type, accounting for about 80% of all strokes. It is caused by a blockage in the blood vessels that supply the brain.
- Hemorrhagic stroke: This type of stroke occurs when a blood vessel in the brain bursts, allowing blood to spill into the brain.
About 15% of cancer patients will experience a ministroke or stroke during their lifetime. Additionally, about 10% of patients hospitalized for a stroke also have cancer.
- Don't smoke or vape
- Get regular exercise, especially aerobic activity
- Eat a Mediterranean diet
- Manage existing health conditions, such as diabetes or high cholesterol
- Monitor heart health and report any irregularities
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How does lung cancer cause hypercoagulability?
Lung cancer can cause hypercoagulability, which is a condition that increases the risk of blood clots. This is due to the cancer itself and the drugs used to treat it, which can alter the properties of the blood, making it "stickier" and more likely to form clots. This can lead to strokes and ministrokes, which are temporary blockages caused by clots in the blood vessels that supply the brain.
The main factors contributing to hypercoagulability in lung cancer patients include:
- Thickness or "stickiness" of the blood: Lung cancer and its treatments can change the properties of blood, making it more viscous and prone to clotting.
- Limited mobility: Cancer patients may have reduced physical activity, which, combined with blood stickiness, further increases the risk of blood clots.
- Hypercoagulability from treatments: Chemotherapy drugs, such as cisplatin and L-asparaginase, have been associated with an increased risk of stroke and thromboembolic events.
- Direct tumor effects: Lung cancer can cause direct compression of blood vessels or release pro-coagulant molecules, leading to clot formation.
- Non-bacterial thrombotic endocarditis (NBTE): Cancer, especially adenocarcinoma, can lead to the development of sterile vegetations on cardiac valves, which can cause systemic and cerebral embolisms.
- Venous-to-arterial embolism: Lung cancer can increase the risk of deep venous thrombosis and pulmonary embolism, which can lead to stroke via venous-to-arterial shunting.
The presence of these factors can increase the likelihood of hypercoagulability and the risk of stroke or ministroke in lung cancer patients.
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What are the symptoms of ministrokes?
A transient ischaemic attack (TIA), or ministroke, is caused by a temporary disruption in the blood supply to part of the brain. This disruption results in a lack of oxygen to the brain, which can cause sudden symptoms similar to a stroke. These symptoms include:
- Speech and visual disturbances
- Numbness or weakness in the face, arms, and legs
The effects of a TIA typically last a few minutes to a few hours and fully resolve within 24 hours. To remember the main symptoms of a TIA, you can use the acronym FAST:
- Face: the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have dropped
- Arms: the person may not be able to lift both arms due to weakness or numbness in one arm
- Speech: their speech may be slurred or they may not be able to talk at all, despite appearing awake; they may also have trouble understanding others
- Time: it's time to call emergency services if you observe any of these signs or symptoms
While the effects of a TIA are temporary, it is crucial to seek medical advice as a TIA is a warning sign that you may be at risk of having a full stroke in the future. An assessment by a medical professional can help determine the best course of action to reduce the chances of a stroke occurring.
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How are ministrokes treated?
A ministroke, or transient ischemic attack (TIA), is a medical emergency that requires immediate treatment. While the symptoms of a ministroke may resolve on their own within minutes or hours, it is crucial to seek prompt medical attention to prevent the occurrence of another ministroke or a full stroke. Here is an overview of how ministrokes are typically treated:
Medications
In the immediate aftermath of a ministroke, treatment focuses on stabilising blood flow to the brain. This may involve starting or adjusting medications such as antiplatelet drugs, which improve blood flow by reducing the ability of blood cells called platelets to stick together and form clots. Examples of antiplatelet medications include aspirin, clopidogrel, and dipyridamole. It is worth noting that these medications can increase the risk of bleeding. Anticoagulant medicines may also be prescribed, particularly if the ministroke was caused by a blood clot in the heart. Examples of anticoagulants include warfarin, apixaban, and dabigatran.
Lifestyle Changes
Making lifestyle changes is an important part of ministroke treatment and can help reduce the risk of another ministroke or a full stroke. These changes may include:
- Eating a healthy, balanced diet: A low-fat, reduced-salt, and high-fibre diet is often recommended, including plenty of fresh fruits and vegetables.
- Regular physical activity: Most guidelines recommend at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week, along with strength exercises on at least two days.
- Quitting smoking: Smoking cessation can significantly lower the risk of having a stroke.
- Reducing alcohol intake: Limiting alcohol consumption to no more than 14 units per week is generally advised.
Surgery
In some cases, surgery may be recommended following a ministroke. One such procedure is a carotid endarterectomy, which involves removing blockages from the carotid arteries—the main blood vessels supplying the head and neck. This surgery can significantly reduce the risk of having a stroke or another ministroke.
Managing Chronic Conditions
Ministroke treatment also involves managing any chronic conditions the patient may have, such as diabetes, high blood pressure, or high cholesterol. Controlling these conditions can help lower the risk of stroke. For example, if a patient has high blood pressure, they may be prescribed antihypertensive medications to control it.
Patient Education and Monitoring
Education and monitoring are also crucial aspects of ministroke treatment. Patients should be made aware of the warning signs of a stroke and the importance of seeking immediate medical attention if these signs occur. Additionally, doctors will typically monitor risk factors such as blood pressure, blood sugar, and cholesterol levels to help prevent another ministroke or a full stroke.
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What are the two types of strokes, and how does the type affect treatment?
While searching for "can lung cancer cause mini strokes", I found information on the two types of strokes, their causes, and treatment options. Here is a detailed overview:
Ischemic Stroke (Clots)
Ischemic strokes are the most common type of stroke, accounting for about 87% of cases in the US. They occur when a blood vessel supplying blood to the brain is obstructed, resulting in brain cell death. This can be due to a blood clot or a buildup of fatty plaque. Ischemic strokes typically present with symptoms such as weakness, numbness, confusion, vision problems, dizziness, loss of consciousness, and severe headaches. Treatment options include medications to dissolve clots or interventions to physically break them up and restore blood flow.
Hemorrhagic Stroke (Bleeds)
Hemorrhagic strokes are less common but tend to progress more quickly and be more severe. They occur when a weakened blood vessel in the brain ruptures or leaks, causing blood loss and pressure injury to the brain cells. Possible causes include aneurysms, arteriovenous malformations, trauma, and uncontrolled high blood pressure. Hemorrhagic strokes have the same basic symptoms as ischemic strokes but are more likely to cause sudden and severe headaches. Treatment focuses on draining blood to relieve pressure and repairing damaged blood vessels to prevent further bleeding.
Transient Ischemic Attack (TIA)
Transient ischemic attacks (TIAs) are often referred to as "mini strokes." They are temporary blockages that cause stroke-like symptoms but usually don't result in permanent damage. However, they serve as a warning sign of a potential full ischemic stroke in the future. TIAs should be taken seriously, and immediate medical attention is advised.
Treatment Differences
The treatment for ischemic strokes involves removing the blood clot, typically with medication but sometimes requiring surgery. Hemorrhagic stroke treatments, on the other hand, focus on stopping the bleeding and reducing side effects associated with brain bleeding. Surgical procedures like clipping or coiling aim to prevent further bleeding. The type of stroke determines the treatment approach, and early diagnosis and treatment improve the chances of a better recovery.
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Frequently asked questions
A ministroke, or transient ischemic attack (TIA), is a temporary blockage in the blood vessels that supply the brain. The physical and neurological deficits caused by TIAs are usually temporary and tend to resolve on their own within a matter of minutes or hours.
Some symptoms of ministrokes to look out for include:
- Facial droop: Does one side of someone’s face appear to be hanging slack? Is their smile uneven? Ask if one side of their face feels numb.
- Arm weakness: Have the person raise both arms above their head and see if one starts drifting down because they can’t hold it up for more than 10 seconds. Strokes and ministrokes usually affect only one side of the body.
- Speech difficulty: Is someone having trouble communicating or not making any sense? Slurred speech can indicate a problem with controlling the mouth muscles. Not being able to answer questions or giving nonsensical answers can indicate a problem with information processing or speech generation.
The two types of strokes are ischemic and hemorrhagic. Ischemic strokes are caused by an arterial blockage that prevents blood from getting to a particular part of the brain and account for about 80% of all strokes. Hemorrhagic strokes involve a blood vessel that has burst, allowing the blood to spill into the brain.
The first thing to do is to administer the National Institute of Health’s (NIH) stroke scale assessment to figure out where the stroke is happening in the brain. Once the problem area is known, steps can be taken to minimize damage and prevent any that’s already occurred from getting worse. After that, the goal is to prevent the next TIA or stroke by managing risk factors. This will often involve some combination of lowering cholesterol immediately, performing an echocardiogram with a “bubble” study to check for a PFO, performing blood vessel imaging of the neck and brain, monitoring heart rhythm over time, controlling blood pressure, giving blood thinners, and more.
