Management

Fiberoptic bronchoscopy is part of the evaluation of a patient with hemoptysis, but it is typically performed after a chest x-ray (CXR).

It is the next step

1. if a CXR shows a (central) mass,
2. if the CXR is normal and there are major risk factors for cancer, or
3. if the CXR is normal and there are no risk factors for cancer, but there is a recurrence of hemoptysis after weeks to months of observation.

Smoker with hemoptysis >> next step is CXR

However, CXR is not part of a routine physical examination of an asymptomatic smoker.

How do you manage a patient with non massive (less than 100 cc in 24 hour) hemoptysis? The work-up begins with history and physical examination. A chest x-ray and laboratory studies should be ordered initially. If the chest x-ray is normal and the patient has risk factors for cancer, like smoking, a bronchoscopy should be ordered to localize the bleeding site and look for an endobronchial mass. If none is found, a high resolution CT scan should be considered. If a mass is found on a study, referral to a thoracic surgeon is necessary.

Chemotherapy

Small cell  -==> Carboplatin and Etoposide

Non-small cell =->

Contraindications to lung cancer surgery include :

1. FEV < 1.5
2. Bilateral disease
3. stage III or IV (metastatic disease)
4. MALIGNANT pleural effusion
5. tumor near hilum (carina, heart or aorta involved)
6. vocal cord paralysis,
7. SVC obstruction,