Factors Associated with Fatal Hemoptysis in Cancer Patients: Conclusion
In patients with a primary bronchogenic tumor, fatal hemoptysis was frequently associated with a necrotic squamous cell carcinoma. Previously, investigators have shown an increased tendency in this cell type to cause tissue necrosis and subsequent hemorrhagic infarction. A proposed mechanism for the development of necrosis in squamous cell carcinoma is tumor invasion of vascular structures leading to ischemia and avascular necrosis, a process similar to that demonstrated in patients with a hematologic malignancy and a fungal pneumonia.
Therapeutic modalities in patients with solid tumors who died from fatal hemoptysis were limited due to the presence of advanced disease. Surgery was not an option, because these patients had either unresectable disease or were not candidates for surgery. Furthermore, maximal radiation therapy had been administered to many of these patients. Other forms of therapy, however, are available. Bronchial artery embolization may be effective treatment for the immediate control of life-threatening hemoptysis.* Similarly, the YAG laser has proved efficacious in the treatment of hemoptysis in patients with lung cancer. These therapeutic measures must be instituted in a timely fashion, because death occurred within 72 hours of the initial episode of hemoptysis in most of our patients with solid tumors. there
In contrast, hemoptysis was frequently nonfatal and often attributable to an endobronchial lesion in patients with a metastatic malignancy. Early broncho-scopic evaluation in patients with hemoptysis and extrathoracic malignancies may therefore have diagnostic value as well as therapeutic implications. We found that hemoptysis in patients with a malignancy is frequently a harbinger of a fatal pulmonary hemorrhage. This catastrophic event is more likely to occur when hemoptysis results from a complication of fungal pneumonia in patients with a hematologic malignancy. A similar outcome can be expected in patients with hemoptysis associated with a necrotic bronchogenic squamous cell carcinoma. Aggressive interventions should, therefore, be initiated in these patients to prevent this fatal complication.