Clinically significant bleeding occurs in approximately 10% of the patients with advanced cancer [1]. Massive bleeding from the nose, pharynx, lung, or gastrointestinal tract constitutes a major challenge; however, it is difficult to predict who will have a serious bleeding event requiring special management and interventions. Bleeding in patients with cancer may present as a localized bleeding diathesis, more often as a result of local injury by tumor invasion or as a generalized hemorrhagic diathesis caused by thrombocytopenia, platelet dysfunction, coagulation factor deficiencies, presence of inhibitors or increased fibrinolysis. Mild persistent bleeding can be distressing for the patient, family members and caregivers; however, catastrophic massive bleeding may also occur, demanding urgent therapeutic intervention. © 2009 Springer-Verlag US.