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Management of Bleeding in Patients with Advanced Cancer

Department of Oncology, University of Calgary, Calgary, Alberta, Canada

Correspondence: Jose Pereira, MBChB, DA, CCFP, Palliative Care Office, Room 710, South Tower, Foothills Medical Centre, 1403-29th Avenue NW, Calgary, Alberta, T2N 2T9, Canada. Telephone: 403-944-2307; Fax: 403-270-9652; e-mail: pereiraj{at}ucalgary.ca

Bleeding occurs in up to 10% of patients with advanced cancer. It can present in many different ways. This article provides a qualitative review of treatment options available to manage visible bleeding. Local modalities, such as hemostatic agents and dressings, radiotherapy, endoscopic ligation and coagulation, and transcutaneous arterial embolization, are reviewed in the context of advanced cancer, as are systemic treatments such as vitamin K, vasopressin/desmopressin, octreotide/somatostatin, antifibrinolytic agents (tranexamic acid and aminocaproic acid), and blood products. Considerations at the end of life are described.

Key Words. Bleeding • Hemorrhaging • Cancer • Palliative