Symptoms - Coughing Up Blood

Reviewed by: HU Medical Review Board | Last reviewed: January 2017.

One of the common symptoms of lung cancer is coughing up blood. The medical term for this is hemoptysis, the presence of blood in the sputum (spit or phlegm) coughed up from the lungs. It is estimated that 7-10 percent of lung cancer patients present (when seen by a medical professional) with hemoptysis and approximately 20 percent experience it through the course of their illness. Lung cancers account for 23 percent of hemoptysis in the United States.1,2

Assessing Hemoptysis

Hemoptysis is an alarming symptom for patients, their loved ones, and their healthcare providers. In assessing blood that is coughed up, physicians first seek to determine where the blood originates (comes from). Sometimes, the blood is not from the lungs but may originate in the nose or upper respiratory tract (pseudohemoptysis) or is a result of vomiting (hematemesis).1,3

The amount of blood is also considered in assessing hemoptysis, although the thresholds of what defines massive versus nonmassive (or mild) hemoptysis are controversial. One measure defines nonmassive hemoptysis as losing less than 200 milliliters of blood per day.1,2

Managing Hemoptysis

The goals of treating hemoptysis are to stop the bleeding, prevent aspiration (inhalation into the lungs), and treat the underlying cause.2Palliative treatment of hemoptysis includes psychosocial support for the patient and family, as well as efforts to stop the bleeding.1 Palliative care is a specialized field that aims to alleviate symptoms and maximize the patient’s quality of life. Palliative care does not focus on curing the disease or prolonging life, which is the goal of other cancer treatments, such as chemotherapy. However, palliative care is an important part of the patient’s treatment plan and encompasses physical symptoms, psychosocial distress, spiritual distress, and caregiver distress.4

For large volume (massive) hemoptysis, the airway must be secured (protected from blockage). This is usually accomplished with an endotracheal tube, which is generally inserted via the mouth or nose. Bronchoscopy, when a narrow tube is placed that allows doctors to view inside the airways and lungs, is used to identify the source of the bleeding, and the bleeding site may be cauterized (sealed). For nonmassive (mild) hemoptysis, bronchoscopy is also used to identify the source of blood. External radiation therapy is recommended in certain situations to treat or stop bleeding. Another option if these measures don’t alleviate the bleeding is to use bronchial artery embolization, the creation of an artificial block, to temporarily stop the bleeding.1,5

Additional symptoms of lung cancer

While coughing up blood is one of the common symptoms in lung cancer, others include:

  • Persistent coughing
  • Wheezing
  • Shortness of breath
  • Chest pain that worsens with deep breathing, coughing or laughing
  • Hoarseness
  • Weight loss
  • Loss of appetite
  • Fatigue or feeling weak
  • Respiratory infections (like bronchitis or pneumonia) that don’t go away or keep returning6

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