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CION Cancer Clinics
Varices explained: swollen veins in the food pipe | CION Cancer Clinics
Varices are swollen veins in the lower food pipe that form when cirrhosis or a liver tumour blocks blood flow through the liver. They cause no symptoms until they burst, and a bleed is an emergency. This page explains why they form, who is at risk, how endoscopy, tablets and banding prevent bleeding, and exactly what to do if someone vomits blood or passes black stools. At CION Cancer Clinics, our team supports patients and families through symptoms, follow-up and life during and after treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What are oesophageal varices?
- Who is more likely to have varices, and to bleed from them?
- How are varices checked and treated before they bleed?
- The words you will meet, in plain language
- Four things families believe about varices, and what is true
- What this page cannot tell you
- Common questions about varices
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Vomiting blood or passing black stools: go to hospital now
If someone with cirrhosis or liver cancer vomits blood, brings up material that looks like coffee grounds, passes black tarry stools, or suddenly becomes faint, pale or drowsy, call an ambulance or go to the nearest emergency department immediately. Do not wait to see if it settles, and do not drive yourself. Lay the person on their side, give nothing to eat or drink, and tell the hospital they have liver disease and may have varices.
The short answer
What are oesophageal varices?
Varices are swollen veins in the lower food pipe, the oesophagus, and sometimes in the stomach. They form when scarring in the liver blocks the normal flow of blood, so blood is forced back and finds detours through thin-walled veins that were never meant to carry it.
Varices cause no pain and no symptoms of their own. Most people only learn they have them from an endoscopy, a camera test down the throat. The danger is that a stretched vein can burst and bleed heavily without warning. That is why doctors look for them early and treat the large ones before they bleed.
Why this matters in liver cancer
Most people with primary liver cancer, called hepatocellular carcinoma or HCC, also have cirrhosis. The tumour itself can add pressure by growing into the portal vein, the main vein carrying blood into the liver. Some cancer medicines also raise bleeding risk. So varices are checked before certain treatments start. Read more about portal hypertension, the raised pressure behind them.
Cancer that has spread to the liver from elsewhere rarely causes varices unless the liver is also badly damaged.Not sure whether this applies to you?
Ask an oncologistWho is at risk
Who is more likely to have varices, and to bleed from them?
Risk is not the same for everyone with liver disease. Your team looks at several things together.
How scarred the liver is
Varices are far more common once cirrhosis is advanced. People whose liver is starting to fail, with fluid in the belly or jaundice, are at higher risk than those whose liver is still coping well.
The size and look of the veins
Large varices, and those with red marks on their surface seen at endoscopy, are more likely to bleed. Small ones may only need watching. Our page on grades of varices explains the terms on your report.
The tumour and the portal vein
When cancer grows into the portal vein, pressure rises further and varices can appear or worsen quickly, even in a liver that was coping before.
Medicines and habits
- Some cancer medicines that affect blood vessels
- Painkillers such as aspirin and other anti-inflammatories
- Continued alcohol, which keeps liver pressure high
- A previous bleed, the strongest warning of another
Finding and treating them
How are varices checked and treated before they bleed?
An endoscopy to look
A thin flexible camera is passed through the mouth under sedation or a throat spray. CION arranges this through partner hospitals and gastroenterologists. See endoscopy at diagnosis for what to expect.
Tablets to lower the pressure
Beta-blockers such as propranolol or carvedilol slow the heart and reduce blood flow into the gut veins. They are taken daily and must not be stopped suddenly without advice.
Banding the larger veins
During endoscopy, small rubber bands are placed around the varices so they shrink and scar. This often needs repeat sessions until the veins are gone.
Planning cancer treatment around them
The tumour board reviews the endoscopy result alongside the scans, so that treatments carrying a bleeding risk are started only once the varices are controlled.
On your report
The words you will meet, in plain language
- Oesophageal varices
- Swollen veins in the lower food pipe. The most common place for varices to form and to bleed.
- Gastric varices
- Swollen veins in the upper stomach. Less common, and treated differently from those in the food pipe.
- Red wale signs
- Red streaks on the surface of a varix seen at endoscopy. They suggest a thin wall and a higher chance of bleeding.
- Portal hypertensive gastropathy
- A fragile, congested stomach lining caused by the same high pressure. It tends to ooze slowly rather than burst.
- Variceal ligation
- The medical name for banding: tying off the veins with small rubber rings during endoscopy.
- Melaena
- Black, sticky, tar-like stools caused by blood digested in the gut. It needs hospital today.
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Commonly believed
Four things families believe about varices, and what is true
"No pain means there is nothing to worry about."
Varices never hurt, even when they are large and close to bursting. The only way to know they are there is to look with an endoscopy.
"A little blood in the vomit can wait until morning."
Any blood, or dark coffee-ground material, in someone with liver disease needs hospital now. A small first bleed can be followed by a much larger one within hours.
"Black stools are from iron tablets, so they are fine."
Iron can darken stools, but bleeding from varices does too. Sticky, tarry, foul-smelling stools, or feeling faint, should be treated as bleeding until a doctor says otherwise.
"Once banded, the varices are gone for good."
Banding shrinks the veins, but the pressure that made them usually remains. New varices can form, so follow-up endoscopies and tablets continue as advised.
Being straight with you
What this page cannot tell you
It cannot tell you whether you have varices, how large they are, or how likely yours are to bleed. Only an endoscopy and your specialist can answer that. It also cannot tell you which tablet or how often banding is right for you, because that depends on your heart rate, blood pressure, kidneys and liver function.
Who this page does not apply to
If your liver is healthy apart from a tumour, or the cancer in your liver spread from the bowel or another organ, varices are much less likely, and this page may not be your concern. Bleeding from a stomach ulcer looks similar but is a different problem with different treatment.
Medicines that need a check first
Some cancer treatments, such as bevacizumab, raise bleeding risk. Read about bevacizumab and varices and ask your oncologist before starting. Do not take over-the-counter painkillers without asking either.
If you are unsure whether an endoscopy has been done or is due, call the helpline and ask.Questions we are asked
Common questions about varices
What should I do if a family member vomits blood?
Call an ambulance or go to the nearest emergency department immediately. Keep them lying on their side so they do not choke, give nothing by mouth, and take their medicine list and liver reports. Tell the hospital they have liver disease and may have varices, so the right team is called quickly.
Can varices be found before they bleed?
Yes. An endoscopy is the standard way to find them, and many people with cirrhosis are offered one when the disease is diagnosed. Some people can skip it if blood tests and liver scans show a low risk. Your hepatologist decides who needs it and how often it is repeated.
Does banding hurt?
The procedure is done under sedation, so most people remember little. Afterwards the chest can feel sore and swallowing may be uncomfortable for a short while, so soft food helps. Severe chest pain, fever or vomiting blood afterwards needs the hospital straight away.
Can I take beta-blockers with my cancer medicines?
Usually yes, but your oncologist and hepatologist should both know every medicine you take. Beta-blockers can lower blood pressure and slow the pulse, so tell your doctor if you feel dizzy or faint. Never stop them suddenly without advice, as that can raise bleeding risk.
Will drinking alcohol make varices worse?
Alcohol keeps damaging the liver and keeps pressure in the portal vein high, so stopping helps at any stage. If stopping is hard, say so honestly. Your team can arrange support without judgement, and sudden withdrawal in heavy drinkers needs medical supervision.
Are varices a sign the cancer is spreading?
Not usually. They mostly reflect cirrhosis and pressure in the liver's veins. New or worsening varices can sometimes follow tumour growth into the portal vein, so your team will look at the scans too. Only they can say what lies behind a change in your case.
Can I eat normally with varices?
Most people can eat a normal, balanced diet with enough protein. Chew well and avoid very hard, sharp foods if your doctor advises it. After banding, soft food is easier for a short time. A low-salt diet may also be needed if there is fluid in the belly.
Where does banding take place?
Endoscopy and banding are done by gastroenterologists at accredited partner hospitals that CION coordinates with. Your team will tell you where it takes place and what to bring. The CION helpline can help you arrange it and keep your cancer care in step.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- Cleveland Clinic — Esophageal Varices: Symptoms, Causes & Treatment
- MedlinePlus — Bleeding esophageal varices
- Merck Manual Consumer Version — Portal Hypertension
- NHS — Vomiting blood
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Vomiting blood: call an ambulance nowExactly what to do in the first minutes of a bleedBanding: tying off the veinsWhat the main treatment involves and how to prepareBeta-blockers to prevent bleedingHow the daily tablets lower the riskWho needs an endoscopy to check for varicesWhether the camera test is due for you
Talk to us
Has anyone checked whether you have varices?
If you have cirrhosis or liver cancer and have not had an endoscopy, our team can review your reports and coordinate one through partner specialists. One helpline serves every CION centre.