There are no entirely specific endoscopic findings indicative of malignancy, however cancerous lesions have been reported to have irregular margins, large “bulls-eye” or “volcano-like” ulcerations, fungating in appearance.1,2,3

In addition to these findings, malignant lesions can still be associated with the more common findings of visible blood vessels and adherent clots. Endoscopic biopsies can help determine if any suspicious lesions are cancerous, and if so, if they represent primary or metastatic lesions.

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Biopsies are typically required to make this distinction between primary and metastatic lesions as no endoscopic findings are specific to either scenario.

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There are several endoscopic options to treat actively bleeding malignant lesions including epinephrine or ethanol injection, argon photocoagulation (APC), bipolar electrocoagulation, and hemoclip.1

It is currently unclear which one of these modalities (or which combination) is most effective at providing hemostasis. If endoscopic hemostasis is either unsuccessful or not possible, additional hemostatic options include chemotherapy, radiation, interventional radiology procedures, or surgery.

There are a lack of data evaluating the use of proton pump inhibitors or H2 receptor blockers in these patients, however they are frequently used. Unfortunately, patients with upper GIB secondary to malignancy have a poor prognosis with relatively high rates of re-bleeding, need for surgery, and mortality.1


  1. Sheibani S, Kim JJ, Chen B, et al. Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy. Aliment Pharmacol Ther. 2013;38(2):144-150.
  2. Loftus EV, Alexander GL, Ahlquist DA, Balm RK. Endoscopic treatment of major bleeding from advanced gastroduodenal malignant lesions. Mayo Clin Proc. 1994;69(8):736-740.
  3. Savides TJ, Jensen DM, Cohen J, et al. Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy. 1996;28(2):244-248.
  4. Oda I, Kondo H, Yamao T, et al. Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases. Endoscopy. 2001;33(6):507-510.
  5. De Palma GD, Masone S, Rega M, et al. Metastatic tumors to the stomach: clinical and endoscopic features. World J Gastroenterol. 2006;12(45):7326-7328.