Stomach cancer bleeding and the resulting anemia are common. It may cause no symptoms or more severe features such as black or melena stools when you go to the toilet.
You may even notice blood if vomiting is an issue. This is known as hematemesis and caused by your malignant ulcer bleeding.
Anemia alone can cause tiredness, breathlessness, headaches, chest pain, muscle pains and much more.
The two main reasons why it occurs in stomach cancer is either because of the vascular nature of your tumor or abnormal clotting that can occur.
Tumors contain a lot of tiny blood vessels as they produce growth factors. These promote vessel formation.
Blood is a necessity for the tumor to survive and proliferate. It is also a necessity to allow the tumor to metastasise or spread to other parts of your body along with local and lymphatic spread.
If the spread occurs to the liver, it's processes can be disrupted including the manufacture of certain clotting factors you needed.
If these clotting factors are absent or low, you are at an increased risk of a bleed.
When cancer involves the bone marrow, your blood cell manufacture can be interrupted. Anemia will ensue as because your platelet clotting cells are affected.
Finally, if you are on chemotherapy, this can suppress the production of your blood cells. It will make you vulnerable to infections, possibly make you anemic and also increase your risk of bleeding should the platelet cell manufacturing be affected.
In a lot of cases, stomach cancer bleeding isn't noticeable and nothing specific needs to be done other than treating any anemia that arises.
However, when it is profuse you may need to have other forms of treatment.
The most common way is to perform an endoscopy test. If there is a blood vessel evident, a clip may be applied to stop any further problems.
In a lot of cases, the bleeding is more diffuse and not caused by a single vessel. In this situation other endoscopic options include cauterising the surface, injection therapy with epinephrine, topical hemostatic agents and on the very rare occasion a radiologist may embolize a blood vessel (clot it off). Surgery is rarely used in this situation.
Any anemia that arises may be treated in several ways.
You may be offered oral iron replacement to improve it. This is an easy option, although Iron intolerance can occur in some people. It too turns your stools black in color and can cause abdominal discomfort and constipation in some.
You may be offered a drug called a PPI or proton pump inhibitor. The most common ones used are Omeprazole and Lanzoprazole which work by reducing the acidity of the gastric contents. They may or may not make a difference to you.
Blood transfusions are often given as a quick and straight forward way of resolving your anemia. They are used as “top ups” when bleeding is more profuse to maintain, your blood pressure, before more permanent ways of settling your symptoms can be undertaken.
The anemia may be found as an incidental finding when you have a blood test and in this situation it is normally treated with iron tablets to replenish your iron stores.
If your anemia is severe, you may require a transfusion.