hemoptysis in lung cancer varies in severity

Hemoptysis
hemoptysis in lung cancer varies in severity
but commonly consists of blood-streaked sputum. the
most common description by the patient is that of coughing
up blood-tinged sputum for several days in succession.
again, these patients are presumed to have bronchitis and are
treated with antibiotics. the index of suspicion is raised if the
symptom persists or recurs particularly in a patient who has a
smoking history. it is prudent to initiate a workup immediately
in a patient younger than 40 years with a smoking history who
presents with hemoptysis. although chest radiographs are usually
abnormal in these patients, some may have a normal study.
in these patients, further diagnostic studies such as sputum
cytology, bronchoscopy, 21 and ct scans should be considered.
detailed history of hemoptysis is essential because presence of
hemoptysis is a contraindication for the use of bevacizumab. in
the clinical trial, eastern cooperative oncology group phase
iii trial (ecog 4599) that evaluated the role of bevacizumab,
presence of half a teaspoon of hemoptysis per episode was an
exclusion criteria. 22
the management of hemoptysis in lung cancer patients depends
on the severity. blood-streaked sputum does not require
any specific therapy other than the therapy for lung cancer.
more severe hemoptysis requires use of antitussives and advising
the patient to sleep with the affected lung in the dependent
position. in patients with advanced lung cancer, chest radiotherapy
is the preferred treatment for moderate hemoptysis. in
patients who have received prior radiotherapy, management of
hemoptysis can be challenging. 23
in certain cases, emergent thoracotomy with resection of
the affected area could be considered. however, technical difficulties
or the general condition of the patient may preclude
such an approach. endobronchial brachytherapy is another
alternative for control of hemoptysis in patients who have received
prior external beam radiotherapy. selective embolization
of bronchial arteries feeding the hemorrhagic area can also
be considered in settings where such expertise exists. 24, 25
massive hemoptysis, which is fairly uncommon in lung
cancer patients, is immediately fatal in many cases. the initial
management of these patients is securing the airway with intubation
or emergent tracheostomy to allow efficient suctioning
of the blood that floods the alveoli, leading to respiratory failure.
bronchoscopy can be performed for both diagnostic and
therapeutic purposes. bronchoscopic instillation of cold saline
solution or vasoconstrictive agents and bronchial balloon
tamponade are some of the therapeutic interventions that
could be implemented. 26 further management of hemorrhage
should proceed based on the clinical condition of the patient.
management of hemoptysis in lung cancer patients requires
sound clinical judgment. many patients with this problem
have a poor prognosis, and any interventions chosen for the
hemoptysis must be consistent with the patient’s prognosis.