Kanser Acilleri ve Karın Ağrısı
Özet
Onkolojik hastalarda karın ağrısı; altta yatan malignite, metastatik yayılım veya uygulanan sitotoksik tedavilerin komplikasyonlarına bağlı gelişebilen karmaşık bir klinik tablodur. Bu hasta grubunda immünsüpresyon ve maskelenmiş semptomlar nedeniyle tanısal güçlükler yaşanabilmekte, ancak sağkalım için hızlı müdahale hayati önem taşımaktadır. Bu yazıda, onkolojik acil durumlar kapsamında değerlendirilen temel intraabdominal patolojiler ele alınmıştır. Özellikle malign bağırsak obstrüksiyonu, gastrointestinal perforasyon, nötropenik enterokolit (tiflit), tümöre bağlı intraabdominal kanama, malign pankreatit ve malign biliyer obstrüksiyon gibi durumların etyopatogenezi, klinik özellikleri ve ilişkili kanser türleri incelenmiştir. Yüksek mortalite ile seyreden bu tablolarda acil serviste erken tanı, stabilizasyon ve multidisipliner tedavi yaklaşımının önemi vurgulanmıştır.
Abdominal pain in oncological patients is a complex clinical entity that may arise from the natural course of the underlying malignancy, metastatic spread, or complications of cytotoxic therapies. Although diagnosis can be challenging due to immunosuppression and masked symptoms in this patient group, rapid intervention is the key determinant of mortality. This chapter details the fundamental intraabdominal pathologies evaluated within the scope of oncological emergencies. Specifically, the etiopathogenesis, clinical features, and associated cancer types of malignant bowel obstruction, gastrointestinal perforation, neutropenic enterocolitis (typhlitis), tumor-related intraabdominal hemorrhage, malignant pancreatitis, and malignant biliary obstruction are discussed. The importance of early diagnosis, stabilization in the emergency department, and a multidisciplinary management approach is emphasized for these high-mortality conditions.
Referanslar
Tuca A, Guell E, Martinez-Losada E, et al. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Management and Research. 2012;4:159–169. doi:10.2147/CMAR.S29297
Verheyden C, Orliac C, Millet I, et al. Large-bowel obstruction: CT findings, pitfalls, tips and tricks. European Journal of Radiology. 2020;130:109155. doi:10.1016/j.ejrad.2020.109155
LeBlanc JF, Martel M, Barkun AN. Examination of physicians' perception of the indications of colorectal stents in the management of malignant large bowel obstruction: a provincial survey. Canadian Journal of Gastroenterology and Hepatology. 2016;2016:4629710. doi:10.1155/2016/4629710
Bosscher MR, van Leeuwen BL, Hoekstra HJ. Surgical emergencies in oncology. Cancer Treatment Reviews. 2014;40(8):1028–1036. doi:10.1016/j.ctrv.2014.05.005
Fujii Y, Hirahara N, Kaji S, et al. Bevacizumab-induced intestinal perforation in a patient with inoperable breast cancer: a case report and review of the literature. Journal of Medical Case Reports. 2018;12(1):84. doi:10.1186/s13256-018-1619-x
Otani K, Kawai K, Hata K, et al. Colon cancer with perforation. Surgery Today. 2019;49(1):15–20. doi:10.1007/s00595-018-1661-8
Inga EE, Badireddy M. Neutropenic enterocolitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559057/ [Accessed 17 December 2025].
Singh P, Nayernama A, Jones SC, et al. Fatal neutropenic enterocolitis associated with docetaxel use. Journal of Oncology Pharmacy Practice. 2020;26(4):923–928. doi:10.1177/1078155219879494
Miller EE, Reardon LC. Neutropenic enterocolitis in a pediatric heart transplant recipient. Case Reports in Transplantation. 2018;2018:3264921. doi:10.1155/2018/3264921
Cheng Y, Ye F, Chen Y. Spontaneous rupture of hepatocellular carcinoma. Journal of Hepatocellular Carcinoma. 2025;12:2421–2428. doi:10.2147/JHC.S540510
Osman UMA, Hassan YSA, Hirei HH. Spontaneous rupture of renal cell carcinoma. International Journal of Surgery Case Reports. 2025;130:111190. doi:10.1016/j.ijscr.2025.111190
Mirfazaelian H, Oryan A, Davari A, et al. Spontaneous splenic rupture in melanoma. Case Reports in Pathology. 2014;2014:865453. doi:10.1155/2014/865453
Wang J, Lyu SC, Zhou L, et al. Prognostic analysis of pancreatic carcinoma. Gland Surgery. 2021;10(1):35–49. doi:10.21037/gs-20-495
Umans DS, Hoogenboom SA, Sissingh NJ, et al. Pancreatitis and pancreatic cancer. World Journal of Gastroenterology. 2021;27(23):3148–3157. doi:10.3748/wjg.v27.i23.3148
Woo JS, Joo KR, Woo YS, et al. Pancreatitis from metastatic small cell lung cancer. The Korean Journal of Internal Medicine. 2006;21(4):256–261. doi:10.3904/kjim.2006.21.4.256
Fayaz A, Shah AH, Khan MA, et al. Multiple myeloma presenting as hypercalcemia-induced acute severe pancreatitis. Gastro Hepato Cell Advances. 2024;4(8):100549. doi:10.1016/j.gastha.2024.09.004
M'harzi S, Elouali A, Lahrache K, et al. Acute pancreatitis following L-asparaginase. Leukemia Research Reports. 2022;18:100357. doi:10.1016/j.lrr.2022.100357
Lorenz JM. Management of malignant biliary obstruction. Seminars in Interventional Radiology. 2016;33(4):259–267. doi:10.1055/s-0036-1592330
Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet (London, England). 2014;383(9935): 2168–2179. doi:10.1016/S0140-6736(13)61903-0
Tsou YK, Su YT, Lin CH, et al. Acute cholangitis. World Journal of Clinical Cases. 2023;11(29):6984–6994. doi:10.12998/wjcc.v11.i29.6984
McDonagh P, Awadelkarim B, Leeds JS, et al. Endoscopic ultrasound-guided gallbladder drainage. Cancers. 2023;15(11):2988. doi:10.3390/cancers15112988
Referanslar
Tuca A, Guell E, Martinez-Losada E, et al. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Management and Research. 2012;4:159–169. doi:10.2147/CMAR.S29297
Verheyden C, Orliac C, Millet I, et al. Large-bowel obstruction: CT findings, pitfalls, tips and tricks. European Journal of Radiology. 2020;130:109155. doi:10.1016/j.ejrad.2020.109155
LeBlanc JF, Martel M, Barkun AN. Examination of physicians' perception of the indications of colorectal stents in the management of malignant large bowel obstruction: a provincial survey. Canadian Journal of Gastroenterology and Hepatology. 2016;2016:4629710. doi:10.1155/2016/4629710
Bosscher MR, van Leeuwen BL, Hoekstra HJ. Surgical emergencies in oncology. Cancer Treatment Reviews. 2014;40(8):1028–1036. doi:10.1016/j.ctrv.2014.05.005
Fujii Y, Hirahara N, Kaji S, et al. Bevacizumab-induced intestinal perforation in a patient with inoperable breast cancer: a case report and review of the literature. Journal of Medical Case Reports. 2018;12(1):84. doi:10.1186/s13256-018-1619-x
Otani K, Kawai K, Hata K, et al. Colon cancer with perforation. Surgery Today. 2019;49(1):15–20. doi:10.1007/s00595-018-1661-8
Inga EE, Badireddy M. Neutropenic enterocolitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559057/ [Accessed 17 December 2025].
Singh P, Nayernama A, Jones SC, et al. Fatal neutropenic enterocolitis associated with docetaxel use. Journal of Oncology Pharmacy Practice. 2020;26(4):923–928. doi:10.1177/1078155219879494
Miller EE, Reardon LC. Neutropenic enterocolitis in a pediatric heart transplant recipient. Case Reports in Transplantation. 2018;2018:3264921. doi:10.1155/2018/3264921
Cheng Y, Ye F, Chen Y. Spontaneous rupture of hepatocellular carcinoma. Journal of Hepatocellular Carcinoma. 2025;12:2421–2428. doi:10.2147/JHC.S540510
Osman UMA, Hassan YSA, Hirei HH. Spontaneous rupture of renal cell carcinoma. International Journal of Surgery Case Reports. 2025;130:111190. doi:10.1016/j.ijscr.2025.111190
Mirfazaelian H, Oryan A, Davari A, et al. Spontaneous splenic rupture in melanoma. Case Reports in Pathology. 2014;2014:865453. doi:10.1155/2014/865453
Wang J, Lyu SC, Zhou L, et al. Prognostic analysis of pancreatic carcinoma. Gland Surgery. 2021;10(1):35–49. doi:10.21037/gs-20-495
Umans DS, Hoogenboom SA, Sissingh NJ, et al. Pancreatitis and pancreatic cancer. World Journal of Gastroenterology. 2021;27(23):3148–3157. doi:10.3748/wjg.v27.i23.3148
Woo JS, Joo KR, Woo YS, et al. Pancreatitis from metastatic small cell lung cancer. The Korean Journal of Internal Medicine. 2006;21(4):256–261. doi:10.3904/kjim.2006.21.4.256
Fayaz A, Shah AH, Khan MA, et al. Multiple myeloma presenting as hypercalcemia-induced acute severe pancreatitis. Gastro Hepato Cell Advances. 2024;4(8):100549. doi:10.1016/j.gastha.2024.09.004
M'harzi S, Elouali A, Lahrache K, et al. Acute pancreatitis following L-asparaginase. Leukemia Research Reports. 2022;18:100357. doi:10.1016/j.lrr.2022.100357
Lorenz JM. Management of malignant biliary obstruction. Seminars in Interventional Radiology. 2016;33(4):259–267. doi:10.1055/s-0036-1592330
Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet (London, England). 2014;383(9935): 2168–2179. doi:10.1016/S0140-6736(13)61903-0
Tsou YK, Su YT, Lin CH, et al. Acute cholangitis. World Journal of Clinical Cases. 2023;11(29):6984–6994. doi:10.12998/wjcc.v11.i29.6984
McDonagh P, Awadelkarim B, Leeds JS, et al. Endoscopic ultrasound-guided gallbladder drainage. Cancers. 2023;15(11):2988. doi:10.3390/cancers15112988
