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 (sometimes called lung cancer cough), and chest pain that worsens with laughing, coughing, or deep breathing.

Oncology researchers estimate that approximately 20 percent of people with lung cancer experience hemoptysis at some point. For some, it may be the first symptom of lung cancer that they experience. Symptoms of lung cancer such as coughing up blood usually occur in advanced stages of lung cancer. Early-stage lung cancer often does not have obvious symptoms.

Keep in mind that hemoptysis is not always a symptom of lung cancer. It may be due to another condition, such as an infection or chronic obstructive pulmonary disease (COPD). 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 of blood.

What Is Hemoptysis?

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 and lung metastases (lung cancer that has spread), other potential causes of hemoptysis include:

• Bronchitis (inflammation of the bronchial tubes)
• Laryngitis
• Nosebleeds
• Throat irritation from persistent or violent coughing

Coughing up blood may also indicate other serious conditions, such as pulmonary embolism (a blood clot in the lung).

Symptoms of Hemoptysis

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, cough, wheezing, fatigue or weakness, and chest pain.

“Has anyone had a problem with coughing up blood?” a MyLungCancerTeam member asked. “I started last night with bright red blood when I coughed. Called the doctor and he was very calm and wanted to know if I was talking 2 cups or 2 tablespoons. … It probably wasn’t even 2 tablespoons. My oncologist called today and decided to move my CT scan up just to be on the safe side.”

Another member wrote, “Last Thursday I coughed up blood all night and went into the emergency room where the doctor cauterized one of my adenocarcinoma stage 4 tumors to stop bleeding. Not sure of next steps, so I’m seeing the pulmonologist Thursday.”

What Causes Hemoptysis in Lung Cancer?

Hemoptysis can result from bleeding in the respiratory tract due to strain or disease. 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 determine a lung cancer diagnosis.

In some cases, a person with lung cancer may 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.

Hemoptysis in Small Cell Lung Cancer

According to an older analysis, the most frequent cause of lung cancer-related hemoptysis is small cell lung cancer (SCLC). Most individuals in the study were found to have a moderate case of hemoptysis (coughing up less than 500 milliliters of blood — about 2 cups — in 24 hours). Around 20 percent of the time, coughing up blood was generally caused by bronchiectasis, and 19 percent of the time, it was the lung cancer itself.

Hemoptysis in Non-Small Cell Lung Cancer

Hemoptysis affects around 20 percent of people with non-small cell lung cancer (NSCLC) at some point in the disease. Of these cases, between 5 percent and 15 percent are considered severe and can be life-threatening.

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 damage in the bronchial arteries. Hemoptysis was found to be related to the bronchial arteries in 82 percent of severe cases.

Hemoptysis After Diagnostic Tests

Certain tests used to diagnose lung cancer and assess lung health may cause a person to cough up blood, including:

• Bronchoscopy, an endoscopic procedure that allows your doctor to view the lungs and air passages from inside
• Spirometry, a test measuring how much air you can breathe in and out of your lungs
• Laryngoscopy, an examination of the larynx — a part of the throat — using a mirror or scope

Biopsies (samples of tissue taken for examination under a microscope) of the lungs or upper airways may also reveal 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.”

Complications of Lung Cancer

In some cases, coughing up blood may be caused by a complication of lung cancer in which another health condition develops due to the lung cancer. Side effects of medication may also cause complications. Complications of lung cancer that may cause hemoptysis include superior vena cava syndrome, pneumonia, or pulmonary embolism.

Diagnosing the Cause of Hemoptysis

Doctors have several different ways of determining the underlying cause of hemoptysis. In some cases, distinguishing between potential 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 determine the cause of your symptoms and work with you to find the best way of managing them.

Questions Your Doctor May Ask

Before beginning any diagnostic testing, a health care provider may start by asking you several questions about your symptoms, including:

• When did you start coughing up blood?
• How frequently does it occur, and at what times of day?
• What does it look like? Is it foamy and pink or bright red?
• Are you also coughing up mucus?
• How much blood do you think you coughed up?

The doctor may ask if you have been experiencing any other symptoms that may point to certain diseases. For instance, pleuritic chest pain — intense, sudden chest pain while breathing — 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 can lead to bleeding and hemoptysis, including:

• Anticoagulants (anticlotting drugs)
• Aspirin
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Diagnostic Testing

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 computed tomography 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. From there, they can devise a plan to control the bleeding and remove blood or other substances from the airways.

Additionally, a lung biopsy or sputum culture may also be taken to provide your doctor with more information. Your doctor also will likely order a blood test to determine whether hemoptysis has led to anemia (low red blood cell count).

It’s important to know that a bronchoscopy or lung biopsy may also cause a person to experience mild hemoptysis.

Treatment Options for Hemoptysis With Lung Cancer

Treatment depends on the cause and severity of the condition. If you experience chronic or severe hemoptysis, your doctor may recommend the following treatments.

Antibiotics

Hemoptysis can occur as the result of infections. If this is the case, your doctor will likely prescribe a course of oral antibiotics to treat the underlying infection.

Cough Suppression

Cough-suppressing opioid medications may be used to help prevent irritation in the lungs and airways due to prolonged or intense coughing. Your doctor may also provide other cough relief recommendations.

Endoscopy

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

Photodynamic therapy (PDT) is one approach to treating lesions that cause hemoptysis. In PDT, a light-sensitive drug 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.

External Beam Radiation Therapy

If a bronchial tumor is found to cause a bloody cough, your health care team may recommend beginning external beam radiation therapy (radiotherapy) to treat the underlying cancer.

When To Visit the Emergency Room

Coughing up blood can be a sign of a serious medical condition. Therefore, it’s generally recommended to go to the emergency room if it’s more than a few teaspoons, or if you’re also experiencing difficulty breathing, dizziness, or chest pain.

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