Bleeding in Cancer by bright nyongo nyirenda - Oncology

Bleeding in Cancer Moderator: dr mwanza presenter: bright nyongo nyirenda OUTLINE Introduction Presentation/Pathology Investigations Management Introduction Bleeding is a frequent problem for patients with advanced cancer, (stage 4) with approximately 10% of all patients having at least one episode and almost 30% in patients with hematologic malignancies. These episodes may range from low-grade oozing to major episodic bleeding or even catastrophic bleeds. It is the immediate cause of death in around 6% of cases Presentation It can present in a variety of ways, from occult bleeds causing anemia over weeks to months, to overt external bleeding from particular anatomical sites. Cancer along the digestive tract can cause bleeding in the stool. Cancer anywhere along the urinary tract can cause bleeding in the urine. Bleeding into the lungs can cause the person to cough up blood. Hematologic cancers; nosebleeds, petechiae, ecchymosis, prolonged hemorrhages from injuries Bleeding malignant wounds Other cancers can bleed into internal areas of the body. Pathology Cancer invasion and destruction: tumor invasion of surrounding tissues leading to destruction of blood vessels and angiogenesis producing fragile blood vessels Treatment-related causes: Mucositic and myelosuppressive effects of chemotherapy and radiotherapy Thrombocytopenia/marrow failure: Hematologic cancers; leukemia, lymphoma and myeloma as well as metastasis to the bone marrow by other forms of cancer Nutritional deficits: In the patient with cancer who is nutritionally compromised, vitamin deficiencies should always be considered Drugs: Anti-coagulants and NSAIDs Concurrent illness, including infection: Local infection within tumour cavities can also increase the risk of bleeding Coagulation disturbances: Cancer causes DIC and the body responds extensively with fibrinolysis which eventually, hemostasis eventually is imbalanced with spontaneous bleeds. Mucositic and myelosuppressive drugs Risk of bleeding Investigations Analysis should include Complete blood count, xmatch Coagulation profile, Complete metabolic panel with assessment of liver enzymes and function. Imaging studies including MRI/CT scan and angiography of the area suspected of bleeding, Endoscopy and colonoscopy for GIT bleeds If infection is thought to precipitate haemorrhage, consider wound swabs and cultures for microbiological identification of pathogens and antimicrobial sensitivities Management Goals of care For patients at risk of catastrophic bleeding, patients and their families should be prepared for the visually and mentally disturbing effects of such an episode. Encourage the use of dark sheets, towels, blankets, and clothing to reduce the visual shock of seeing a massive bleed. Instructing family/caregivers how to apply pressure if there is a specific bleeding site, instructing family/caregivers how to position a patient with massive hemoptysis or hematemesis Fast acting sedatives such as intravenous or subcutaneous midazolam should be available, and families should be instructed on their use if the patient is at home. Urgently move the patient to a health center for clinical management Management END!!!!! IF YOU WERE NOT PAYING ATTENTION!!!!!!!