Bleeding Colorectal Tumors
Colorectal tumors are the third most common source of acute lower gastrointestinal bleeding, after diverticulosis and hemorrhoids. Additionally, tumors account for a very common source of chronic occult bleeding. The choice of approach to evaluation and m
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Bleeding Colorectal Tumors Cristan E. Anderson and Paula I. Denoya
Overview Colorectal tumors are an uncommon source of an acute life threatening hemorrhage, but a very common cause of occult gastrointestinal bleeding. In fact, asymptomatic anemia is a common indication for workup which ultimately reveals a cancer. This chapter provides a guide to the clinician regarding the presentation, workup, and treatment of bleeding colorectal tumors.
Incidence Colonic tumors are the third most common source of lower gastrointestinal bleeding. In a study of 1112 patients admitted with lower gastrointestinal bleeding, Gayer et al. [1] found that 12.7 % of the patients had bleeding due to neoplasia. The most common sources of bleeding were diverticulosis (33.5 %) and hemorrhoids (22.5 %). The incidence did not change over time. The incidence of colorectal cancer has been steadily declining in the older population due to the increased prevalence of screening colonoscopy with polypectomy; however, the incidence in young patients continues to increase [2]. Therefore, colorectal cancer must be in the differential of all patients presenting with gastrointestinal bleeding, regardless of age.
C.E. Anderson, M.D., M.P.H. • P.I. Denoya, M.D. (*) Department of Surgery, Stony Brook University Hospital, Stony Brook, NY 11794, USA e-mail: [email protected]; [email protected] © Springer International Publishing AG 2016 A.D. Pryor et al. (eds.), Gastrointestinal Bleeding, DOI 10.1007/978-3-319-40646-6_15
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C.E. Anderson and P.I. Denoya
Etiology Benign colonic tumors which can present with bleeding include hemangiomas, leiomyomas, lipomas, and adenomatous polyps. Polyps may be classified as serrated polyps, hamartomas, which can be associated with various genetic syndromes including Peutz–Jeghers syndrome, juvenile polyposis, and Cronkhite–Canada syndrome, and adenomas which are considered to be precancerous lesions [3]. Additionally, malignant lesions which can present with bleeding may include adenocarcinoma, squamous cell carcinoma, and lymphomas. This chapter focuses on the malignant lesions as they are more commonly responsible for significant bleeding.
Presentation and Evaluation Bleeding from colorectal tumors can be divided into three broad categories with implications for workup and management: chronic, acute, and massive.
Chronic Bleeding Chronic bleeding will most likely come to the clinician’s attention upon review of laboratory values, either ordered as a routine screening procedure, or when obtained for symptoms, either related or unrelated to anemia. Symptomatic anemia may result in weakness, dizziness, fatigue, or occasionally signs of myocardial ischemia such as arrhythmia, or dyspnea upon exertion. Rarely, anemia may be profound enough to trigger a myocardial event such as angina or even myocardial infarction. Patients will present with an anemia due to occult blood loss. The initial workup of this patient should include a colonoscopy, and most patients will also undergo an upper en
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