Head and neck haemorrhage

Bleeding in head and neck cancer can vary from small recurrent bleeds of no haemodynamic importance to the so-called 'carotid blow out' caused by erosion of the internal carotid artery. The latter is fatal in a matter of minutes. A warning 'herald bleed' can sometimes occur prior to such an event.

Recurrent small bleeds arise as a result of degradation of small intra-tumoural blood vessels. This symptom can sometimes be the presenting complaint. Bleeding can arise from the mucosal surfaces, from skin ulceration, or can be stomal following surgical treatment.

Significant bleeds arise from major vessel erosion (arterial or venous). This can occur in recurrent disease, often following surgery to the neck or in the advanced neglected primary. Significant bleeds from the neck most often arise following malignant infiltration of major neck vessels by metastatic lymphadenopathy.

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