Persistent Cough and Blood in Sputum: Is It Lung Cancer?

Q: Persistent Cough and Blood in Sputum: Is It Lung Cancer?

Dear Inquirer： If the chest X-ray is normal and you continue to have blood-tinged sputum, it is advisable to consult a pulmonologist for a bronchoscopy. <br>Changhua Hospital cares about you.

I'm not sure what's wrong?

In 2016, a family member was diagnosed with squamous lung cancer, despite having no history of smoking.
They experienced six months of treatment, but unfortunately, it could not reverse the advanced malignant tumor that had metastasized.
That Christmas, my mother passed away.
In early 2017, feeling anxious, I went for a self-paid low-dose computed tomography (LDCT) scan and a 64-slice coronary computed tomography.
As a young person, I received a report indicating only a suspected shadow in the lungs, likely from a past cold.
The doctor said there were no significant issues.

By mid-2017, an elder who had lived in my home for 20 years, constantly smoking and drinking, was finally asked to leave, thus no longer being exposed to secondhand smoke.
This elder also had thyroid cancer but did not specifically receive flu vaccinations.
Over the past two years, I have been wondering if my immune system has been weaker, as I have been experiencing prolonged colds.
During last year's severe flu season, I would cough and wheeze at night, taking at least one to two months to recover.
I later discovered that I had persistent phlegm, and I noticed some red streaks in my sputum upon waking and before sleeping, which has been quite bothersome.

I consulted a gastroenterologist who ordered an X-ray, which showed a clear chest cavity.
I took medication for bronchitis for a month, and although the gastroscopy showed some redness, it was still considered normal.
In 2019, prior to the flu season, a chest X-ray (CXR) indicated normal heart size and no definite focal lung lesions, with sharp bilateral costophrenic angles.
It suggested correlation with clinical conditions and follow-up.
In 2020, the gastroenterologist stated that the chest film was clear: the heart and mediastinum were essentially normal in size and contour, with exaggerated lung markings over both lungs.
The bony thoracic cage and both hemidiaphragms were intact.

However, the red streaks in my phlegm have not improved on their own.
Should I be concerned that this might indicate lung cancer, or do I need to undergo another self-paid health check and get an LDCT scan?

Niming, 20~29 year old female. Ask Date: 2020/11/18

Dr. Huang Yiwen reply Pulmonology

Dear Inquirer: If the chest X-ray is normal and you continue to have blood-tinged sputum, it is advisable to consult a pulmonologist for a bronchoscopy.
Changhua Hospital cares about you.

Reply Date: 2020/11/18

More Info

Understanding persistent cough and blood in sputum can be a source of significant anxiety, especially when there is a family history of lung cancer, as in your case. It’s important to approach this situation with a clear understanding of the potential causes and the necessary steps for evaluation.

Firstly, the presence of blood in sputum, known as hemoptysis, can arise from various conditions, not just lung cancer. Common causes include infections (like bronchitis or pneumonia), chronic obstructive pulmonary disease (COPD), tuberculosis, and even benign conditions such as bronchiectasis or pulmonary embolism. In your case, given the history of persistent cough and blood-streaked sputum, it is crucial to consider these alternatives seriously.

You mentioned that you have undergone several imaging studies, including chest X-rays (CXR) and a low-dose computed tomography (LDCT) scan, which have shown no significant abnormalities. This is reassuring, as lung cancer typically presents with more definitive findings on imaging studies. However, the persistence of blood in your sputum warrants further investigation, particularly if it continues or worsens.

The fact that you have a family history of squamous lung cancer and have experienced prolonged respiratory symptoms can understandably heighten your concern for lung cancer. However, it is essential to remember that lung cancer is less common in non-smokers, and your imaging results have not indicated any malignancy. The presence of blood in sputum can also be related to irritation or inflammation of the airways, which can occur due to chronic bronchitis or other respiratory conditions, especially if you have had recurrent respiratory infections.

Given your symptoms and the previous evaluations, it would be prudent to consult a pulmonologist. A bronchoscopy may be recommended, which involves inserting a thin tube with a camera into the airways to directly visualize the lungs and obtain samples if necessary. This procedure can help rule out any underlying pathology that may not be visible on imaging studies.

In terms of your question about whether you should undergo another LDCT scan, it may be beneficial to discuss this with your healthcare provider. If your symptoms persist despite previous evaluations, a repeat scan could provide additional information. However, it is essential to weigh the risks and benefits of additional radiation exposure against the likelihood of finding something significant.

Lastly, it is crucial to maintain open communication with your healthcare provider about your symptoms and concerns. Keeping a symptom diary, noting when the blood appears in your sputum, and any associated symptoms (like cough, fever, or weight loss) can provide valuable information for your doctor.

In conclusion, while the presence of blood in sputum can be alarming, it is not exclusively indicative of lung cancer, especially in the context of normal imaging studies. A thorough evaluation by a specialist, including a possible bronchoscopy, can help clarify the cause of your symptoms and guide appropriate management. Remember, early detection and intervention are key in managing any respiratory condition effectively.

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