Question: Good Morning doctor,

I would like to consult you further in response to a question I posted last month about seeing blood in saliva/spit when clearing throat and GERD symptoms and my worry about lung cancer.

I went to see my GP again after your response earlier and started with Pantoprazole (40mg) once a day. My GP also listened to lung sounds and said that my chest is clear.

Its been 3 weeks taking Pantoprazole and my GERD symptoms have subsided, back pain is gone, chest pain has somewhat subsided though I still feel intermittent pain in one particular area of the chest - below right clavicle and towards centre of the chest.

Also, bleeding from throat hasn't improved at all, I would say it has remained the same or slightly worsened. I have minor to zero coughing and I haven't ever saw blood during or after coughing - its only when I clear my throat I see blood mixed with the spit.

My GP prescribed Pantoprazole for 30 days and I have completed 22 days without an improvement in bleeding. I have also made some lifestyle changes for GERD as you earlier suggested.

Could you please advise the next course of action? I feel that if it hasn't improved in 22 days, it wont even after 30 days.
Should I complete the 30 day course or go to GP now and ask for more aggressive diagnosis since I am worrying a lot about lung cancer?

Hello doctor,

Thanks for your reply.

I haven't consulted an ENT doctor yet as my GP hasn't referred me to any specialist. He keeps assuring me that I am not displaying any signs of lung cancer, based on his year 20 year experience in medical profession.

But for some reason, I am unable to put my mind at ease and keep having a bad feeling about all this.

Apart from bleeding from throat, my other symptoms have improved though. I used to clear my throat too often which has also gone down. But seeing blood everyday is making me anxious.

At this moment, I am not even sure how much blood I am losing daily. I am able to spot blood after waking up in the morning because it keeps building up throughout the night. But I don't know whether I am bleeding whole day because during the day, I keep swallowing saliva and there is no time for sufficient blood to built up to be seen with the naked eye.

I don't have fever, weight loss, night sweats etc so at this moment I am totally confused and anxious about what is happening to me.

Hope you understand. Thanks.

Hello doctor,

Thanks for your reply.

My initial spit contains spots of blood in the saliva. Upon further clearing the throat , I believe the blood mixes with the spit because I have to (sort of) suck up the blood. I haven't noticed mucous, its mostly spit/saliva. Even if there is any mucous, I would say its minimal because I cannot notice it with the naked eye.

I am attaching a picture of the blood that comes after sucking up and then spit (not the initial spit). I have to do this 4-5 times and then it becomes clear.

I live in Melbourne, Australia and the health system here doesn't allow consultation with the specialist directly. I have to get a referral from the GP to see the specialist.

My GP didn't seemed very bothered about the symptoms when I first told him about the bleeding. He asked me to send a picture of what it looks like and the same I am attaching here for you to look at. He also told me to visit after finishing the course of Pantoprazole and said that if the bleeding persists, he will order further tests.

Please have a look at the image of blood I have attached and let me know your thoughts. The image is of a single spit. I spit blood 4-5 times the same amount and then it becomes clear.

Regards,
XXXX

Hello doctor,

Thanks for your reply.

I don't have any known history of dental disease.

During my last visit, my GP had a look at my throat and teeth/gums as well and said that I neither have 'red throat' nor any lesions in mouth/gums.

Could you please guide me further as to how can I take an image of the oral cavity? I only have a camera in my cellphone but I think it may not be sufficient for a clear image.

Thanks and regards,
XXXX

Thanks doctor, I have just uploaded a couple of images. Please have a look.

Sorry doctor, I have attached a couple of fresh images. Please see if they are of any help.
Its the best I could manage. :)

Hello doctor,

I understand and really appreciate being thorough.

I will try to more pictures of my teeth and gums tomorrow morning and will send you.

But just for my knowledge, have you seen any cases like me before that eventually led to diagnosis of cancer of lungs or any other cancer?

Thanks and regards,
XXXXX

Hello doctor,

Thanks for your help.

I have never smoked in my life. However, after moving to Australia 3 years ago, I have been exposed to secondhand smoke quite often because majority of my friends who I hang out are addicted to smoking.

I have never undergone a chest CT-Scan. But I have undergone Chest X-Ray as a part of my Visa requirements 3 years ago. They didn't raised any medical concerns while granting my Visa so I assume my X-Ray was clear back then. But I didn't have access to the actual report.

I am seeing blood in spit for about a month now.


Thanks and regards,
XXXXX

Hello Doctor,

As I have stated in my medical history, I have been having intermittent Chest and back pains for the past 7-8 months. All the time my GP said that my chest is clear after hearing sounds through stethoscope.

And then I started seeing blood in spit a month ago.

I looked up these symptoms on various health portals and some of them list out lung cancer as one of the causes (though with a low probability). Also I have read people sharing their stories on health portals stating that they or their relatives got lung cancer even though they never smoked but were exposed to second hand smoke.
My main reason to worry about lung cancer is frequent exposure to second-hand smoke for the past 3 years (after moving to Australia).

I do admit that after taking Pantoprazole my heartburn and back pain is gone, and chest pain has eased a little (although not completely gone).

Also, none of my family member (Father, Mother, brothers, maternal and paternal grandparents, uncles and aunts, cousins) has ever been diagnosed with Lung cancer.
My brother had a bout of TB and Pulmonary Oedema around 10 years ago but he is also in decent health after recovering from it.

Sorry to bother you so much but I am just very nervous these days as my throat bleeding isn't getting better.


Thanks and regards,
XXXXX

Hello Doctor,

Thanks for your reply.

I did requested my GP for X-Ray and blood tests, etc but he told me that he didn't felt the need for it.

I will further reply to your questions tomorrow along with the image of teeth and gums.

Appreciate a lot for your understanding and assurances.

Have a good day.


Thanks and regards,
XXXXX