Internal Bleeding with Esophageal Cancer: Causes, Symptoms and Treatment Options
What is Esophageal Cancer?
The National Institute of Cancer defines esophageal cancer as “cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach).” It is a cancer of the upper part of the digestive system and includes all those type of cancer that develop specifically in the esophagus.
According to the American Cancer Society, there are approximately more than 16 thousand new cases of esophageal cancer per year in the United States and more than 10,000 people die each year in this country due to this disease.
There are two basic types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. At present the adenocarcinoma type is the most prevalent type while squamous carcinoma was more frequent a few years ago. Although risks factors have been discovered (alcohol, tobacco, genetics) it is not completely understood why the shift from one type to another.
Internal Bleeding with Esophageal Cancer
Internal bleeding is a common complication seen with esophageal cancer. The bleeding is due to the rupture of distended veins that form in the esophageal walls. Internal bleeding with esophageal cancer can be a serious threat to the patient. The portal vein (a large vein that carries blood from the stomach and the intestines to the liver) blood pressure may increase dramatically due to esophageal cancer and internal bleeding. Portal vein high blood pressure will affect the liver and intestines.
The signs and symptoms of internal bleeding in people with esophageal cancer include:
- stools with blood spots
- black stools
- low urine output
- being thirsty all the time
- vomiting blood
- liver disease
There are a variety of procedures that can be performed to diagnose this complication. A rectal examination and feces analysis will look for blood in both the rectum and stools. A more sophisticated procedure, called Esophagogastroduodenoscopy (EGD) will examine the esophagus in detail (with a camera mounted on a plastic tube that will be inserted through your mouth or nose and into the esophagus) and will look for places within the esophagus where internal bleeding might be happening.
Depending on the severity of the internal bleeding there are different options to stop it. If the bleeding is acute, the bleeding can be stopped by placing a band around the vein which is bleeding. This procedure will involve using endoscopy to guide the procedure. Also, if the vein that is bleeding is small it can be injected with a coagulant to stop the bleeding.
If the bleeding is not acute there are some medications that can be used to stop it. For example, nadolol, propranolol (beta blockers) and vasopressin and octreotide can be used.
Jobe et al. 2009. Esophageal Cancer: Principles and Practice. Demos Medical Publishing. ISBN 9781933864174
American Cancer Society. Cancer Facts and Figures 2010. American Cancer Society, 2010.
National Cancer Institute. https://www.cancer.gov/cancertopics/types/esophageal