Symptoms – Coughing Up Blood

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% of lung cancer patients present (when seen by a medical professional) with hemoptysis and approximately 20% experience it through the course of their illness. Lung cancers account for 23% of hemoptysis in the United States.1,2

Assessing the Symptom of Coughing Up Blood

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 track (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 is controversial. One measure defines nonmassive hemoptysis as losing less than 200 milliliters of blood per day.1,2

Managing the Symptom of Coughing Up Blood

The goals of treating hemoptysis are to stop the bleeding, prevent aspiration (inhalation into the lungs), and treat the underlying cause.2 Palliative 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 through 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

Other Symptoms of Lung Cancer

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

Written by: Emily Downward | Last reviewed: January 2017.
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