title: Diverticular Bleeding of the Colon during Combination Chemotherapy with Bevacizumab and Paclitaxel for Recurrent Breast Cancer.
abstract: BACKGROUND
  Bevacizumab has been increasingly used in combination chemotherapy with paclitaxel for treatment of metastatic or recurrent breast cancer. The aim of this report is to underline possible risks associated with the new combination chemotherapy.
  
  
  METHODS
  A 39-year-old woman with recurrent breast cancer was treated with bevacizumab and paclitaxel. Positron emission tomography revealed breast cancer metastasis to the left supraclavicular lymph nodes and right axillary lymph nodes, with no distant metastasis.
  
  
  RESULTS
  After the third cycle of bevacizumab and paclitaxel, the patient developed a bloody bowel discharge. Emergent colonoscopy demonstrated diverticular bleeding on one of the multiple diverticula in the ascending colon. The bleeding point was successfully clipped colonoscopically.
  
  
  CONCLUSIONS
  The factors for diverticular bleeding are believed to be non-steroidal anti-inflammatory drugs, constipation, and bevacizumab. We recommend reviewing anamneses for diverticulitis, multiple prior abdominal surgeries, peritoneal carcinomatosis, and regular use of certain drugs.
authors: Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Yoshie
authors: Y
authors: Nakayama
authors: Yoshinori
authors: Y
authors: Ito
authors: Masahiko
authors: M
authors: Tanabe
authors: Shunji
authors: S
authors: Takahashi
keywords: Adverse effects; Bevacizumab; Breast cancer; Diverticular bleeding; Non-steroidal anti-inflammatory drugs; Opioid analgesics; Paclitaxel