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Article written byWhat Is Hemoptysis? | Symptoms | Causes | Diagnosis | Treatment
Although alarming, coughing up blood — also known as hemoptysis — is a common symptom of lung cancer. This respiratory symptom may be accompanied by wheezing, increased sputum (mucus or phlegm) production, persistent cough, and chest pain that worsens with laughing, coughing, or deep breathing.
Researchers estimate that approximately 20 percent of people with lung cancer experience hemoptysis at some point. For between 7 percent and 35 percent of people, it may be the first symptom of lung cancer that they experience.
Keep in mind that hemoptysis is not always indicative of lung cancer. That said, if you start coughing up blood, call 911 or seek emergency medical treatment. Getting prompt medical attention is especially important if your coughing is accompanied by severe dizziness, lightheadedness, or shortness of breath or if you cough up more than a few teaspoons’ worth of blood.
Hemoptysis refers to coughing up blood from the respiratory tract, as opposed to blood that comes from the throat, mouth, or digestive tract.
Besides lung cancer, other potential causes of hemoptysis include bronchitis (inflammation of the bronchial tubes), laryngitis, nosebleeds, and throat irritation from persistent or violent coughing. Coughing up blood may also indicate other serious conditions, such as a blood clot in the lung (pulmonary embolism).
Blood that is coughed up from the respiratory tract may be bright red or pink. It may also appear frothy or bubbly because it has mixed with mucus, air, or sputum.
If you have lung cancer, you may experience other symptoms alongside hemoptysis, including shortness of breath, wheezing, fatigue, weakness, and chest pain.
The lung’s structure itself is predisposed to hemoptysis. The airways have a very close anatomical relationship to the blood vessels, which help transfer oxygen to the body and eliminate carbon dioxide. Moreover, the alveolar-capillary membrane — where these gasses are exchanged between the lung’s structures and the blood — is rich with small blood vessels known as capillaries.
Hemoptysis can result from bleeding in any part of these structures. However, coughing up blood is most commonly caused by bleeding in the bronchial system, which includes the trachea, bronchi, alveolar ducts, alveolar sacs, and alveoli.
Different types of lung cancer may cause a person to cough up blood. So, too, may procedures used to diagnose lung cancer,
In some cases, a person with lung cancer may start to cough up blood if a tumor in the lungs’ structures has damaged surrounding blood vessels. The most common cause of coughing up blood is bronchiectasis — damage and widening of the airways.
According to an older analysis, the most frequent cause of lung cancer-related hemoptysis is small-cell lung cancer. Most individuals in the study were found to have a moderate case of the symptom (coughing up less than 500 milliliters of blood in 24 hours). The hemoptysis was generally caused by bronchitis, as well as the lung cancer itself.
Hemoptysis affects between 20 percent and 60 percent of people with non-small cell lung cancer (NSCLC) at some point in the disease. Of these cases, between 5 percent and 10 percent are considered severe.
One study published in the European Respiratory Journal looked at hemoptysis in people with NSCLC. It found that in 52 percent of cases, coughing up blood was related to the bronchial arteries. Hemoptysis was found to be related to the bronchial arteries in 82 percent of severe cases.
Certain tests used to diagnose lung cancer may cause a person to cough up blood, including:
Biopsies of the lungs or upper airways may also result in hemoptysis. As one MyLungCancerTeam member asked, “I’m worried about coughing up blood after a biopsy. Is this normal?” Another member replied, “Small amounts are normal for a day or so — only small amounts. I’ve had several biopsies from both lungs with little trouble.”
Doctors have several different ways of determining the underlying cause of hemoptysis. In some cases, however, distinguishing between different sources of the coughed-up blood can be difficult. Blood originating from the stomach, for instance, may be mistaken for blood coughed up from the respiratory tract.
If you start coughing up blood, it is important that you seek immediate medical care. Your health care team will be able to determine the cause of your symptoms and work with you to find the best way of managing them.
Before beginning any diagnostic testing, a health care provider may start by asking you several questions about your symptoms, including:
The doctor may ask if you have been experiencing any other symptoms that may point to certain diseases. For instance, intense, sudden chest pain during breathing (pleuritic chest pain) may indicate a blood clot or infection in the lungs, while pain that spreads to the back may indicate problems with the heart.
A doctor may also ask if you have a history of smoking and whether you are taking any medications. Certain medications, including anti-clotting drugs (anticoagulants), aspirin, and nonsteroidal anti-inflammatory drugs, can lead to bleeding and hemoptysis.
To determine the cause of hemoptysis, a doctor will likely perform a thorough physical examination. Early on, the doctor also will likely order some imaging tests — such as a chest X-ray, a lung scan, or a chest CT scan. These can help reveal physical problems that may be causing a person to cough up blood.
Diagnostic tests generally follow imaging tests, including a bronchoscopy. A bronchoscopy can help your doctor determine the source of the blood you are coughing up and allow the doctor to control bleeding and remove blood or other substances from the airways. (Note, however, that a bronchoscopy may also cause a person to experience mild hemoptysis.)
Additionally, a lung biopsy or sputum culture may also be taken to provide your doctor with more diagnostic information. Your doctor also will likely order a complete blood count to determine whether hemoptysis has led to anemia (low red blood cell count).
How a person’s hemoptysis is treated will depend on the cause of the symptom and its severity. If you experience chronic or severe hemoptysis, your doctor may recommend the following treatments.
Hemoptysis can occur as the result of infections. If this is the case, your doctor will prescribe a course of oral antibiotics to treat the underlying infection.
Cough-suppressing opioid medications may be used to help prevent irritation in the lungs and airways due to prolonged or intense coughing.
If you are experiencing severe, long-lasting hemoptysis, your doctor will need to stop the bleeding via a bronchoscopy and an endoscopic procedure. This entails inserting a surgical device down through the esophagus.
Photodynamic therapy (PDT) is one approach to treating lesions responsible for hemoptysis. In PDT, a light-sensitive drug called Photofrin (porfimer sodium) is injected into the tumor and activated with laser light. Several days later, a doctor will perform a bronchoscopy to remove dead tissues from the treated area.
If a bronchial tumor is found to be responsible for a bloody cough, your health care team may recommend beginning external beam radiation therapy (radiotherapy) to treat the underlying cancer.
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Have you experienced hemoptysis? Share your experience in the comments below, or start a conversation by posting on MyLungCancerTeam.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.
