A patient with an occult malignancy may develop hemorrhage during anticoagulant, antiplatelet or thrombolytic therapy. The possibility of an occult malignancy should be considered in a patient with unexpected bleeding even if it can be explained by excessive anticoagulation. Early identification of an occult tumor can result in improved outcomes for the patient.


Sites with occult malignancy that may present with hemorrhage:

(1) upper gastrointestinal tract

(2) colorectum

(3) urinary tract

(4) female genital tract or from the nipple

(5) retroperitoneum

(6) intra-cranial tumor, including metastases

(7) respiratory tract


The bleeding site should be identified and its nature determine, especially if it is an ulcerated and/or mass lesion.


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