Differences between patients with and without cancer in other clinical features shown in Table 3 were in the direction expected but were not statistically significant, possibly due to the small number of patients with cancer. Patients with cancer tended to have greater duration, but not volume, of hemoptysis, consistent with the results of other studies.2* Chronic obstructive pulmonary disease, recently shown to be an independent risk factor for lung cancer, was more common in cancer patients. In addition, cancer patients were somewhat more likely to have weight loss and hoarseness and less likely to have evidence of acute bronchitis than patients without cancer. so
Nonlocalizing abnormalities on chest roentgenogram tended to be more common in patients with cancer, as suggested by Peters et al. Although the occurrence of these abnormalities was significantly associated with age, there also was a significantly higher frequency of chest roentgenogram abnormalities which might prevent clear visualization of the central lung fields (primarily tortuous aorta) in cancer patients. Chest roentgenograms with such findings should not be regarded as negative in patients with hemoptysis.
The majority of cancers detected in this study appeared to be resectable, and half were detected at a very early stage. These results suggest that the bronchoscopic diagnosis of lung cancer may provide substantial benefit to these patients. Few comparable data are available in the literature. Three of the six lung cancers found by Kallenbach et al were noted to be inoperable and none of the remaining three appears to have been diagnosed at an early stage.
Our finding of six additional lung cancers during follow-up, two of which appear likely to have been present at the time of evaluation for hemoptysis, leads us to question the previous assertion that a negative bronchoscopic examination excludes cancer as a cause of hemoptysis. Lung cancers diagnosed subsequent to a negative bronchoscopic examination have been consistently reported in series which give follow-up information. Four of the five cancers reported at follow-up in these series were diagnosed within two years of the index evaluation. These data suggest that a substantial proportion of the lung cancers occurring in these patients may be missed by bronchoscopy, indicating that the diagnosis of cancer should be considered even after a negative bronchoscopic examination.