Hi Cancergrace,
Last month my sweeties 6 month post pneumonectomy ct showed a representative prevascular lymph node that grew from 6 to 9 mm since 11/13 scan. In addition, scattered mediastinal nodes increased in size from prior study but no dimensions listed. Mediastinal node pathology was negative at surgery.
Last night he awoke from sleep coughing/choking and ran to the bathroom. I recall several episodes of coughing/choking waking me up. This morning I found evidence of bright red blood on the wall that he must have missed when cleaning up last night. So I ask about coughing up blood and he concedes reluctantly because he knows I will call a doctor. Nothing on pillow though. Mentioned in past but will repeat, my sweetie has dementia and is a very unwilling patient but eventually yields.)
I have a call into thoracic surgeon who is his lead doc but spoke with NP who will get back to me later. My questions are:
1. How does one determine how much blood comes up? I was always amazed at how little blood was responsible for my monthly female trouble.
2. How much blood is too much and signals a trip to ER, sit tight and call cancer doc next day or call PCP?
3. Is thoracic surgeon appropriate to be lead on case given sweetie had adjuvant chemo and now tracking lymph nodes (next CT was moved up to 4 months instead of 6)? If not, then which specialist?
Thanking you in advance for your dedication to keeping me and others educated and sane through this unpredictable cancer journey.
Lisa
Reply # - August 5, 2014, 12:19 PM
Reply To: Prevascular lymph node 9 mm and coughing blood
Hi Lisa,
I'm sorry that he is having such trouble. You may want to review this thread which discusses coughing up blood: http://cancergrace.org/forums/index.php?topic=9368.0 In that thread, Dr. Weiss states:
"Coughing up blood is certainly common in NSCLC, but is not normal per se. The goal of management of small volume hemoptysis (coughing up blood) is to rule out any dangerous causes that can cause you problems. This typically starts with history, physical examination and imaging and often progresses to include bronchoscopy (looking down at the airways with a scope). At the minimum, I would tell your oncologist and (if you have one) pulmonologist."
In another thread, Dr. West stated: "The most concerning issue is bright red blood, but any situation of coughing up blood, especially persistently, is concerning enough to get a real diagnosis." - http://cancergrace.org/forums/index.php?topic=2003.msg11897#msg11897
Dr. Sanborn has also stated:
"Coughing up blood can range from something very mild to very serious, but I always tell my patients that if they are coughing blood they need to notify me so we can troubleshoot. Blood is extremely irritating to the sensitive lung tissue, and can quickly cause problems." - http://cancergrace.org/forums/index.php?topic=4462.msg26748#msg26748
For both legal and practical reasons, no one here on GRACE can tell you whether you should head to the ER, but perhaps you can ask either your oncologist or pulmonologist (or their staff) for some guidance on that question.
JimC
Forum moderator
Reply # - August 5, 2014, 03:46 PM
Reply To: Prevascular lymph node 9 mm and coughing blood
I agree with Jim. It's appropriate to call one of the doctors directly involved with his care, and a pulmonologist or the thoracic surgeon would be the most appropriate to evaluate further. A bronchoscopy would be a way to try to directly visualize a source of bleeding, which sometimes can be managed directly during the bronchoscopy (such as by cauterizing any area of bleeding).
Short of measuring what is coughed up, you can only estimate whether the amount of blood is a tinging/spotting, some streaks, or frank blood in spoonfuls or more at a time. The more there is, the more worrisome and needing of urgent attention.
Good luck.
-Dr. West