CA: A Cancer Journal for Clinicians, Vol 28, 7-16, Copyright
© 1978 by American Cancer Society
Differential Diagnosis of Upper Gastrointestinal Bleeding and Cancer
Paul Sherlock M.D.1 and
Sidney J. Winawer M.D.2
1 Chief, Gastroenterology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Professor of Medicine, Cornell University Medical College, New York, New York.
2 Director, Diagnostic Gastrointestinal Unit, Gastroenterology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Associate Professor of Medicine, Cornell University Medical College, New York, New York.
Since most patients with upper gastrointestinal bleeding and cancer are not hemorrhaging from their tumors, it is clear that an aggressive diagnostic approach is essential to identify the source of bleeding. Early endoscopy should therefore be performed after stabilization of the patient and lavage of the stomach with iced saline. If massive bleeding prevents visualization, diagnostic angiography may be necessary.
Bleeding from vanices or from a single gastric or duodenal ulcer may be demonstrated in this manner, but gastric mucosal bleeding is more difficult to identify. Endoscopy is the preferred diagnostic method for gastric erosions—the most frequent cause of upper gastrointestinal hemorrhage—since barium X-ray studies cannot visualize these superficial lesions. In our series, endoscopy was able to diagnose the source of bleeding in 90 percent of patients.
Although it has not been conclusively demonstrated that the mortality rate from upper gastrointestinal hemorrhage is altered by early, more accurate endoscopic diagnosis, it is evident that treatment decisions can be made clearly and rapidly and transfusion requirements lessened. In addition, various centers have been looking into newer methods for the successful treatment of bleeding from gastric mucosal lesions and from peptic ulcers using endoscopic electrocoagulation, lasers, infrared heat probes, tissue adhesives and pharmacologic agents such as prostaglandins, Cimetidine and growth hormone. However, the successful use of any of these modalities depends upon rapid and accurate diagnosis.
