Digestive Diseases and Sciences

, Volume 62, Issue 2, pp 491–501 | Cite as

Gastrointestinal Bleeding Due to Gastrointestinal Tract Malignancy: Natural History, Management, and Outcomes

  • Richard A. Schatz
  • Don C. Rockey
Original Article



Gastrointestinal (GI) tumor bleeding can vary from occult bleeding to massive hemorrhage and can be the presenting sign of malignancy.


Our primary aims were to: (1) characterize the natural history, treatment, and outcomes in patients with GI tumor bleeding and (2) compare and contrast bleeding in upper GI (UGI)/small bowel (SB) and lower GI malignancies.


Patients with endoscopically confirmed tumor bleeding were identified through search of consecutive electronic medical records: Bleeding was determined by the presence of melena, hematochezia, hematemesis, or fecal occult blood. Comprehensive clinical and management data were abstracted.


A total of 354 patients with GI tumors were identified: 71 had tumor bleeding (42 UGI/SB and 29 colonic). GI bleeding was the initial presenting symptom of malignancy in 55/71 (77%) of patients; 26/71 patients had widely metastatic disease at presentation. Further, 15 of 26 patients with metastatic disease presented with GI bleeding. Visible bleeding was present in 14/42 (33%) and 4/29 (14%) of UGI/SB and colonic tumors, respectively. Endoscopic hemostasis was attempted in 10 patients, and although initial control was successful in all, bleeding recurred in all of these patients. The most common endoscopic lesion was clean-based tumor ulceration. Overall mortality at 1 year was 57% for esophageal/gastric, 14% for SB, and 33% for colonic tumors.


When patients with GI malignancy present with GI bleeding, it is often the index symptom. Initial endoscopic hemostasis is often successful, but rebleeding is typical. Esophageal and gastric tumors carry the poorest prognosis, with a high 1-year mortality rate.


Neoplasm Hematemesis Melena Hemorrhage Ulcer Mass 



Charlson Comorbidity Index






Lower GI


Small bowel


Upper GI


Authors’ contributions

RS was involved in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content. DR was involved in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and study oversight.

Compliance with ethical standards

Conflict of interest

The authors certify that they have no financial arrangements (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, honoraria) with a company whose product figures prominently in this manuscript or with a company making a competing product.


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:9.CrossRefGoogle Scholar
  2. 2.
    Imbesi JJ, Kurtz RC. A multidisciplinary approach to gastrointestinal bleeding in cancer patients. J Support Oncol. 2005;3:101–110.PubMedGoogle Scholar
  3. 3.
    Cihoric N, Crowe S, Eychmüller S, et al. Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy. Radiat Oncol. 2012;7:7–132.CrossRefGoogle Scholar
  4. 4.
    Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34:643–664.CrossRefPubMedGoogle Scholar
  5. 5.
    Macrae FA, St John DJ. Relationship between patterns of bleeding and Hemoccult sensitivity in patients with colorectal cancers or adenomas. Gastroenterology. 1982;82:891–898.PubMedGoogle Scholar
  6. 6.
    Kim YI, Choi IJ. Endoscopic management of tumor bleeding from inoperable gastric cancer. Clin Endosc. 2015;48:121–127.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Allum WH, Brearley S, Wheatley KE, et al. Acute haemorrhage from gastric malignancy. Br J Surg. 1990;77:19–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Sheibani S, Kim JJ, Chen B, et al. Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy. Aliment Pharmacol Ther. 2013;38:144–150.CrossRefPubMedGoogle Scholar
  9. 9.
    Savides TJ, Jensen DM, Cohen J, et al. Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy. 1996;28:244–248.CrossRefPubMedGoogle Scholar
  10. 10.
    Molto A, Dougados M. Comorbidity indices. Clin Exp Rheumatol. 2014;32:131–134.Google Scholar
  11. 11.
    Eberst ME, Berkowitz LR. Hemostasis in renal disease: pathophysiology and management. Am J Med. 1994;96:168–179.CrossRefPubMedGoogle Scholar
  12. 12.
    Guzzo TJ, Dluzniewski P, Orosco R, et al. Prediction of mortality after radical prostatectomy by Charlson Comorbidity Index. Urology. 2010;76:553–557.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Heller SJ, Tokar JL, Nguyen MT, et al. Management of bleeding GI tumors. Gastrointest Endosc. 2010;72:817–824.CrossRefPubMedGoogle Scholar
  14. 14.
    Wagner AD, Unverzagt S, Grothe W, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev. 2010;17:CD004064.Google Scholar
  15. 15.
    Paoletti X, Oba K, Burzykowski T, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA. 2010;303:1729–1737. doi: 10.1001/jama.2010.534.CrossRefPubMedGoogle Scholar
  16. 16.
    Loftus EV, Alexander GL, Ahlquist DA, et al. Endoscopic treatment of major bleeding from advanced gastroduodenal malignant lesions. Mayo Clin Proc. 1994;69:736–740.CrossRefPubMedGoogle Scholar
  17. 17.
    Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2:394–397.CrossRefPubMedGoogle Scholar
  18. 18.
    Kim YI, Choi IJ, Cho SJ, et al. Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer. J Gastroenterol Hepatol. 2013;28:1489–1495.CrossRefPubMedGoogle Scholar
  19. 19.
    Stapley S, Peters TJ, Sharp D, et al. The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records. Br J Cancer. 2006;95:1321–1325.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Caldarella A, Crocetti E, Messerini L, et al. Trends in colorectal incidence by anatomic subsite from 1985 to 2005: a population-based study. Int J Colorectal Dis. 2013;28:637–641.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Internal MedicineMedical University of South CarolinaCharlestonUSA

Personalised recommendations