Does early stages of lung cancer show up in a chest x-ray?

There are so many first manifestation of lung cancer, you should go to meet a doctor to get the most accurate results if you have the following symptoms:

If you are of young age let's say below 50 years old and you don't have other risk factors for lung cancer such as cigarette smoking, family history, etc, I wouldn't be worried about lung cancer especially after a negative chest x-ray. The size of the cancer lesion also determines if it will show up on x-ray or not. That's why very early stages won't show up on x-ray. Also, it is common to find a small solitary nodule lesion on chest x-ray and if upon follow-up it doesn't increase in size it's nothing to worry about as some of these lesions happen due to a healed infections and are thus normal.

As for the blood, I would like to ask you if you recently quit smoking? If you did do so, then the blood is most likely from rebuilding of capillary vessels in your respiratory tract lining. This is because when you quit smoking, new healthy capillaries start to grow to make up for the damaged epithelium lining the smoking had caused. In other words, it's a sign of good healthy repair. These capillaries are fragile in the beginning and can bleed easily such as by coughing. So, it can show up as blood. I was in college when I quit smoking, and a few weeks later I noticed blood in my sputum, and I was freaking out. Well that was the cause, it was healthy repair of my respiratory lining. Which is a good thing.

Bottom line is that after a negative chest x-ray I would not worry about lung cancer. If you are a heavy alcoholic or binge drinker, then you can get it checked out as well by a physician as there are also other causes of blood in sputum. But if you indeed recently quit smoking, I would rest assured and sleep peacefully and make sure I don't have worsening bleeding in my sputum over the coming weeks, I would also look out for any signs of infection such as fever, and I would stay away from smoking and alcohol, and I would not force myself to cough just to forcefully bring out sputum to examine it, as this would further damage the small capillaries that are rebuilding and recovering your epithelial lining.