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What Causes Coughing Spells When Diagnosed With Mucoepidermoid Carcinoma?

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Posted on Mon, 16 Nov 2015
Question: Dear Sir/Madam
I had low grade mucoeipidermoid carcinoma 4 years ago. I have no local recurrence. I had perineural invasion. I am 30 now.
From last 4 days I have been experiencing HEMOPTYSIS. Each day ONCE at night. But I have OCCASIONAL cough, not persistent at all. I have GERD too. I have also bleeding problem from throat sometimes after eating solid food and also quick drinking of water. LPR reflux.
CHARACTERISTICS:- Once coughing out blood, I cough several times intentionally to know the more blood is coming out or not. But nothing is coming.
1) Once coughing out blood, I cough several times to know more blood is coming or not. But no blood is coming after that. why?
2) From last 4 days, each day I coughed up blood once. But there after I am coughing several times but nothing is coming. Please cite the reason.
3) Is it typical sign of lung cancer?
4) I have heard that hemoptosis in lung cancer is persistent and after coughing several times blood also comes many times. But in my case it is happening only once. Please give the reason.
Is it lung cancer?
5) I had low grade mucoepidermoid carcinoma, could it metastasize to lungs?
Please read it carefully and answer.
I am going to hospital for chest X-Ray and Pharynx endoscopy but it will take 2 days.
Please reply as quick as possible and tell the truth not to encourage.( sometimes it done to encourage patients).
Thank You.
doctor
Answered by Dr. Indranil Ghosh (16 hours later)
Brief Answer:
most probably from upper respiratory tract

Detailed Answer:
Hi
Thanks for your query.

I have read your query carefully. My answers below..

1. The characteristic of the bleeding you have described most commonly goes with upper respiratory tract problems like pharyngitis. Hence no blood is coming on repeated coughing. But if you continue to cough repeatedly just for checking, you will further injure your throat and more problems will start. So please stop doing that

2. Same query with same answer

3.No this is not typical of lung cancer. And lung cancer is extremely rare in your age. Particularly if you are non-smoker

4.Yes hemoptysis in lung cancer is recurrent and persistent

5. Low grade mucoepidermoid carcinoma is a rare diagnosis and not many long term follow-up series are there. However, whatever data we have say that chance of lung metastasis is rare.

Hope I have answered your query. I have given all facts to you and made up nothing to encourage you. I am available for follow-up.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (5 hours later)
Thank You very much Sir.
I'll definitely stop intentional coughing.
Dear Sir
Today I have done flexible Endoscopy of Naso-pharynx, Oro-pharynx, Hypo-pharynx, larynx and Trachea also visible. But no where any cut or scar mark was found. I have GERD problem.
1) But the major problem is when I am sitting or playing or talking on phone, suddenly I feel blood sensation in my mouth when I spit there is little blood. All the things happen without COUGH.As there is no scar mark, from where the blood is coming?
2) Occasionally when I cough then spit the mucus there is NO BLOOD. But after 5-10 second there is blood sensation in my mouth when I spit there is blood. Then I cough up several times to know the source of blood but nothing comes.
Is it typical sign of lung cancer?
3) In lung cancer there is blood accumulation in lung from tumor necrosis, invasion of pulmonary artery or vein. Can a single bout of COUGHING clear the all blood from lung so that no blood is coming from SECOND time coughing?
If blood comes to mouth through Trachea few steaks should be on trachea too which would be cleared by second time coughing.
Is this true that hemoptysis is continuous atleast for few minutes for above reason? or
Please give the explanation from your point of view.
In early symptom, is hemoptysis is also continuous?
4) I have almost no cough but sometime I have throat irritation especially at night. Is it true pattern of cough for lung cancer?
5) Can hemoptysis occurs without persistent cough?

Please read it carefully. Sorry for asking these type of awkward questions. It is scaring me that is why I am asking.
Thank You.
doctor
Answered by Dr. Indranil Ghosh (11 hours later)
Brief Answer:
please refer below

Detailed Answer:
Hi
Thanks for followup.

This time I will answer in a consolidated fashion as some of the questions are overlapping.

Just based on symptoms, distinguishing between lung cancer and other causes is not possible. In general we can get an idea only. In your case my idea was upper respiratory. But as that is negative, we need to dig deep by doing a CT scan of thorax.

Beyond that, I don't think I can answer specifically your other queries just based on symptomatology.

I understand that you are scared but there is no point scare pushing you to the limit. Get the necessary investigations done, it will surely remove your fear. I still feel strongly that this is not recurrence or lung cancer.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Indranil Ghosh (2 hours later)
Thank You Sir for your reply.
I'll definitely do all the necessary investigation. I have already taken appointment for that because I'am staying in certain area where all the tests are not readily available. Before that just I want to know the probable diagnosis to convince myself ONLY. Anyway it will not alter the final outcome.

Literally speaking I have only 2 problems.
1) One is automatic bleeding in mouth while playing, eating, drinking water,talking on phone etc. which comprises 95% of time. But test came NEGATIVE.
2) Coughing of blood which happened only 4 times in 4 months. But no time it is along with mucus. It happened after coughing clear mucus then after 5-10 second blood sensation in my mouth when I spit then little blood comes.
I wonder because Is it due cough or not.
That is why I am asking you regarding hemoptysis. I have no other problem.

So I am requesting you to answer the previously asked( second follow-up) questions as you have enough experience, by that time my test result may have come. So please reply sir.
doctor
Answered by Dr. Indranil Ghosh (2 hours later)
Brief Answer:
Ok, plese see below

Detailed Answer:
My answers..
1) But the major problem is when I am sitting or playing or talking on phone, suddenly I feel blood sensation in my mouth when I spit there is little blood. All the things happen without COUGH.As there is no scar mark, from where the blood is coming?

A. Difficult to say , will need CT scan and/or bronchoscopy

2) Occasionally when I cough then spit the mucus there is NO BLOOD. But after 5-10 second there is blood sensation in my mouth when I spit there is blood. Then I cough up several times to know the source of blood but nothing comes.
Is it typical sign of lung cancer?

A. No this is not typical of lung cancer

3) In lung cancer there is blood accumulation in lung from tumor necrosis, invasion of pulmonary artery or vein. Can a single bout of COUGHING clear the all blood from lung so that no blood is coming from SECOND time coughing?
If blood comes to mouth through Trachea few steaks should be on trachea too which would be cleared by second time coughing.
Is this true that hemoptysis is continuous atleast for few minutes for above reason? or
Please give the explanation from your point of view.
In early symptom, is hemoptysis is also continuous?

A. hemoptysis may not be continuous in early lung cancer. But it is rare to see every time only the first cough has blood and not subsequent ones

4) I have almost no cough but sometime I have throat irritation especially at night. Is it true pattern of cough for lung cancer?

A. No this is not suggestive of lung cancer

5) Can hemoptysis occurs without persistent cough?
A. Yes it can but usually in upper respiratory problems (or even mouth problems like dental problem) as to throw up blood from lung you need cough reflex to work
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Indranil Ghosh (6 hours later)
Thank You very very much Sir for your reply.

I also consulted ENT specialist, he also said in upper respiratory tract even though there is no significant injury mark but it still possible of very little bleeding as it happens average once in 4-5 days. I too have slight gum problem as there less saliva due to removal of parotid gland and followed by radiation therapy. I have also GERD problem. Sometime I also saw blood after quick drinking of water and sometime pink blood(without vomiting) comes after taking banana. He said it may due to LPR( laryo-pharyngeal reflux).

But the real worry was cough which I was not sure about blood from lung or throat. I have already described about that. It happened only 4 times in 4 months. It happened due to persistent cough due to GERD. But for last 2 months I have controlled my food habits and cough is almost nil for last 2 months.

I have already taken appointment for necessary investigation. I will definitely consult you after getting test report. I worried because of my previous carcinoma problem. That is why i asked these type of question.

Thank You for your patient reading and reply.
doctor
Answered by Dr. Indranil Ghosh (12 hours later)
Brief Answer:
Ok please send the reports when ready

Detailed Answer:
Most likely this problem will also settle down with time.

Regards
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1712 Questions

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What Causes Coughing Spells When Diagnosed With Mucoepidermoid Carcinoma?

Brief Answer: most probably from upper respiratory tract Detailed Answer: Hi Thanks for your query. I have read your query carefully. My answers below.. 1. The characteristic of the bleeding you have described most commonly goes with upper respiratory tract problems like pharyngitis. Hence no blood is coming on repeated coughing. But if you continue to cough repeatedly just for checking, you will further injure your throat and more problems will start. So please stop doing that 2. Same query with same answer 3.No this is not typical of lung cancer. And lung cancer is extremely rare in your age. Particularly if you are non-smoker 4.Yes hemoptysis in lung cancer is recurrent and persistent 5. Low grade mucoepidermoid carcinoma is a rare diagnosis and not many long term follow-up series are there. However, whatever data we have say that chance of lung metastasis is rare. Hope I have answered your query. I have given all facts to you and made up nothing to encourage you. I am available for follow-up. Regards