Gastrointestinal Bleeding in the Cancer Patient
Section snippets
Etiology
The major causes of UGIB in both cancer and noncancer patients are summarized in Box 1. Less commonly, cancer from various primary sources can metastasize to the esophagus, stomach, or duodenum and may be present with GIB ranging from an occult bleed to a significant hemorrhage. Lymph node disease from either primary GI lymphoma or metastatic disease can also erode through overlying mucosa and become a source of significant bleeding. In addition, mucositis related to chemotherapy can lead to
Lower gastrointestinal bleeding
Acute LGIB is one of the most common GI indications for hospitalization, increasing dramatically with age.49 Colorectal cancer, commonly presenting with LGIB, is the fourth most commonly diagnosed cancer and second leading cause of cancer-related deaths in the United States.50 Approximately 147,000 cases are diagnosed annually with over 57,000 deaths.50 Depending on patient population, somewhere between 1% and 17% of acute LGIB is due to colonic neoplasms.51 Postpolypectomy bleeding accounts
Summary
UGIB has a relatively high mortality rate despite advances in treatment and detection. Although cancer is a less likely primary cause of upper GI bleeding, hematologic and anatomic cancer-related changes complicate the work-up and management of UGIB. Additionally, cancer treatments can have a variety of consequences that can lead to occult or massive hemorrhage. Initial management for GI bleeding is similar in patients with and without cancer; however, special consideration must be given to
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2021, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :IVT is contraindicated in patients with structural gastrointestinal (GI) malignancy due to increased risk of bleeding.12 Interestingly enough, etiology of bleeding in patients with GI malignancies is not considered different compared to general population, with peptic ulcers, esophageal varices and erosive lesions contributing to bulk of cases.31 In cases where tumor is itself contributing to active bleeding, presentation is mostly chronic blood loss.32
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2020, Seminars in RoentgenologyCitation Excerpt :GI bleeding in cancer patients has similar etiologies as in noncancer patients. The neoplasms themselves are the source of bleeding only in 2.9%-4.0% of upper GI bleeding cases and about 19% of lower GI bleed cases.101 The presence of cancer, metastatic disease, and lymphoproliferative disorders increases the risk of upper GI bleeding by 21%, 50%, and 95%, respectively.
Transcatheter arterial embolization for gastrointestinal bleeding related to pancreatic adenocarcinoma: clinical efficacy and predictors of clinical outcome
2020, European Journal of RadiologyCitation Excerpt :Massive transfusion and TNM stage 4 were related to failed TAE. Advanced adenocarcinoma seems to make it more difficult to control the bleeding, not only because of adjacent major vascular invasion, but also because of vascular erosion or tissue necrosis caused by chemotherapy or radiotherapy [38,39]. Furthermore, it might be reasonable that massive transfusion is associated with poor clinical outcomes and which is a consequence of massive bleeding or severe coagulopathy [40,41]
Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia
2019, Gastrointestinal Endoscopy