Treatment of gastrointestinal bleeding due to cancer

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Gastrointestinal bleeding due to cancer includes both upper and lower gastrointestinal bleeding. Treatment of gastrointestinal bleeding due to cancer according to many different regimens. However, the treatment process needs to be urgent and according to the principles of active resuscitation, which is volume compensation, blood replacement, and blood pressure elevation.

1. Treatment of hemostasis

1.1 Basic first aid movements

Gastrointestinal bleeding will aggravate blood loss. If not treated promptly, the patient can die. Basic first aid movements include:
Place the patient in a low head position. Oxygen with a concentration of 2-6 liters/minute, intubation if the patient is at risk of regurgitation into the lungs, respiratory failure or impaired consciousness. Insert two large and stable intravenous lines. If the patient has heart failure, a central venous catheter should be placed to measure central venous pressure (CVP). Place a urinary catheter in the patient to monitor urine output. Insert a nasogastric tube to clear the blood in the stomach if it is upper gastrointestinal bleeding. If the patient is elderly, or has coronary artery disease, ... it is necessary to conduct an acute electrocardiogram.

1.2 Volume recovery and shock resistance

While waiting for blood collection, proceed to infusion of 0.9% NaCl solution, Ringerlactate or macromolecular solutions such as heastril, genlafuldin,... Limit the use of 5% glucose because it has little effect to compensate for the volume. vessel lumen. The amount and rate of infusion will depend on the extent of blood loss and the patient's cardiovascular status. The goal is to bring the patient out of shock. (Relative blood pressure > 90 mmHg, urine > 30 ml/hour, cessation of irritability). Need to monitor pulse, blood pressure, listen to the lungs, measure CVP (central venous pressure), monitor urine, ...

1.3 Blood transfusion

Blood transfusion in cases of heavy and progressive bleeding: stabilize hemodynamics and HCT (RBC ratio and total blood volume) > 25% (for the elderly, patients with cardiovascular disease) , respiratory failure,... >30%). Infusion of fresh frozen plasma for patients with coagulopathy, prothrombin ratio < 30%. Platelet thrombocytopenia if platelet count <50,000/mm3, is common in liver cancer in patients with severe cirrhosis. SEE ALSO: Diagnosis and treatment of gastrointestinal bleeding

2. Treatment of gastrointestinal bleeding according to the cause

2.1 Interventional endoscopy

Inject local hemostasis with polodocanon,... Inject local vasoconstrictor (adrenalin 1mg) for cases of gastrointestinal bleeding due to colorectal cancer, gastrointestinal cancer.
In case of bleeding due to rupture of esophageal varices in liver cancer patients with cirrhosis, emergency sclerotherapy or rubber band ligation. Coordinating the placement of a Sengstaken Blake More catheter is relatively effective, but this method is only temporary.
If biliary tract bleeding, perform interventional retrograde cholangiopancreatography.

2.2 Medical treatment

Infusion of drugs that inhibit secretion of fluid such as: omeprazole, pantoprazol 80mg/24h,... or ranitidine, cimetidine,... infusion of cold water through gastric tube in case of bleeding due to gastric cancer.
Infusion of drugs to reduce portal pressure such as: Somatostatin (Somatin 3mg) injected 0.25mg, then mixed with 0.9% NaCl IV infusion 6mg/24h for 3-5 days or Vassopressin 0.1-0 ,8 UI/ effective hemostasis in 60-80% of cases. Combined with oral beta-blockers such as propranolone, betaloc,...
Interventional angiography in hemostasis: selective embolization by gelatin gel, direct infusion of vasopresin into the bleeding artery.

2.3 Surgical removal of the tumor

Esophageal resection and reconstruction in esophageal cancer . In gastrointestinal cancer, surgery to remove the stomach partially or completely. Cholangiocarcinoma resection, then biliary anastomosis in cholangiocarcinoma.
Resection of the colon with tumor for colorectal cancer,... For the cases of rupture of the esophageal vein in liver cancer with cirrhosis, the portal anastomosis will stop the bleeding about 95 %. However, the risk of hepatic encephalopathy and death is high. After that, when the patient's condition is stable, the combination of radiation therapy or systemic chemotherapy will be combined.
In summary, there are many methods to treat gastrointestinal bleeding due to cancer, but treatment needs to be urgent and according to the principles of active resuscitation, which is volume compensation, blood replacement, and blood pressure elevation.
Gastrointestinal bleeding is a dangerous medical emergency, if delayed and improperly handled, it can affect life. Therefore, besides treating as soon as gastrointestinal bleeding is detected, cancer patients need to have regular health checkups, have a suitable diet and rest.
Currently, Vinmec International General Hospital System has applied the technique of Endoscopy to hemostasis with clips in gastrointestinal bleeding in many cases, with absolute advantages such as the current equipment system. Modern equipment: Avance CS2 anesthesia machine, GE's R860 ventilator, endoscope.... 6 ultrasound rooms, 4 DR X-ray rooms (1 full-axis scanner, 1 intensifier, 1 synthesizer and 1 mammography machine), 2 DR mobile X-ray machines, 2 receiver multi-row computer tomography rooms (1 machine with 128 rows and 1 machine with 16 rows), 2 rooms for Magnetic Resonance imaging (1 machine 3 Tesla and 1 machine). 1 machine 1.5 Tesla), 1 interventional angiography room 2 planes and 1 room to measure bone mineral density....A place to gather a team of experienced doctors and nurses who will greatly assist in the diagnosis. early detection and detection of abnormal signs of the patient's body. In particular, with a space designed according to 5-star hotel standards, Vinmec ensures to bring patients the most comfort, friendliness and peace of mind.

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