Gastrointestinal bleeding in critically ill cancer patients

Cancer patients are at higher risk factor for gastrointestinal (GI) hemorrhage. In addition, the cancer diagnosis predicts poorer outcomes from the hemorrhage. Management is complicated by the expanded differential for sources of bleeding not only fromthe cancer but its therapy. In addition, cancer or its therapy can lead to bone marrow suppression with resulting thrombocytopenia that can exacerbate blood loss. New targeted therapy agents have unique properties leading to unusual adverse events like perforation and immune-mediated colitis. However, management strategies exist and are of proven benefit in these challenging patients. Endoscopy plays a critical role not only in establishing etiology but in control of hemorrhage. Direct tumor bleeding is problematic but does respond to endoscopic measures although recurrence rates are high. Additional nonendoscopic therapy directed toward tumor may be beneficial in reducing recurrence rates. Overall prognosis in GI bleeding is good, but cancer patients have higher risk of rebleeding and mortality.