Oncology Certified Nurse Practitioner and freelance healthcare writer with over a decade of medical oncology and hematology experience.

Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor.

Coughing up blood, or hemoptysis, can be an anxiety-producing experience. Hemoptysis occurs when blood is brought up, possibly along with mucus, when someone coughs. This blood can come from somewhere inside the lungs and respiratory tract. Though hemoptysis can potentially have a variety of causes, such as pneumonia or bronchitis, it can also be caused by lung cancer.

Sometimes hemoptysis is one of the first signs that someone has lung cancer. It also is a somewhat common symptom of lung cancer. One study reports that about 20% of people with lung cancer will have hemoptysis.

This article will review important facts about hemoptysis, such as when to see a healthcare provider, how it's treated, and how it impacts life expectancy. 

The amount of blood coughed up can differ based on the location of the bleeding. If the cancer is affecting an area of the lung near a large artery, the bleeding can be significant, with large amounts of blood being brought up. Anything more than a teaspoon or so of blood requires immediate medical attention.  

Medical attention should be sought immediately as well even if the blood is in smaller amounts but has the following symptoms present l:

If the amount of blood is small, more in streaks mixed with mucus than pure blood, and only happens occasionally, it should still be brought to the attention of your healthcare team quickly. 

Treatment of hemoptysis depends upon the amount and location of the bleeding. 

The first step to starting treatment is to determine exactly where the bleeding is occurring. This can be done through imaging, such as a CT (computed tomography) scan, or by directly looking at the airway with a camera during a bronchoscopy (visualizing the lungs and air passages using a thin, flexible tube with a light). Once the source of bleeding is located, some measures that can be done to treat it include:

The ultimate life expectancy for someone with lung cancer varies based upon the stage in which it's diagnosed. Generally, the earlier lung cancer is found, the more likely it can be cured. However, hemoptysis is a sign of poor prognosis.

Severe hemoptysis can be immediately life-threatening if the bleeding can’t be stopped. One study showed that those with hemoptysis have a lower survival rate as compared to those who didn't have hemoptysis. The study showed that 41% of subjects with lung cancer were still alive at six years with hemoptysis compared to 67% of those without hemoptysis.  

Hemoptysis, or coughing up blood, is a symptom that may be present in those living with lung cancer, but it may have other causes as well. Anyone who experiences hemoptysis should be evaluated to find the source of the bleeding. If hemoptysis happens occasionally, with a small amount of blood, it's not as urgent as significant, frequent bleeding. 

The treatment of hemoptysis can change based on the amount of bleeding and the cause but can include medications, surgery, or treatment of cancer. 

Having hemoptysis can be a very scary experience, and it should be brought to the attention of your healthcare team. If there is a lot of bleeding or if you’re experiencing any chest pain or trouble breathing, call 911 or seek emergency care immediately.

There are multiple causes for coughing up blood. It may be due to a lung infection, such as bronchitis or pneumonia, or lung cancer. 

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American Academy of Family Physicians. Hemotpysis.

Walter FM, Rubin G, Bankhead C, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer. 2015;112(1):S6-S13.

Cleveland Clinic. Coughing up blood.

Gershman E, Guthrie R, Swiatek K, Shojaee S. Management of hemoptysis in patients with lung cancer. Ann Transl Med. 2019;7(15):358.

Hu P, Wang G, Cao H, Ma H, Sui P, Du J. Haemoptysis as a prognostic factor in lung adenocarcinoma after curative resection. Br J Cancer. 2013;109(6):1609-1617.

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