In most cases where lung cancer is suspected, it is appropriate to arrange an urgent chest xray before urgent referral to a chest physician.

However, a normal chest x-ray does not exclude a diagnosis of lung cancer.

In patients with a history of asbestos exposure, mesothelioma should be considered.

Refer for urgent suspicion of cancer chest x-ray for any of the following:

  • Any unexplained haemoptysis
  • Unexplained and persistent (more than 3 weeks):
    • change in cough or new cough
    • dyspnoea
    • chest/shoulder pain
    • loss of appetite
    • weight loss
    • chest signs
    • hoarseness (if no other symptoms present to suggest lung cancer refer via Head & Neck pathway)
    • fatigue in a smoker aged over 40 years
  • New or not previously documented finger clubbing
  • Persistent or recurrent chest infection
  • Cervical and/or persistent supraclavicular lymphadenopathy*
  • Thrombocytosis where symptoms and signs do not suggest other specific cancer**
  • Any person who has consolidation on chest x-ray should have further imaging no more than 6 weeks later to confirm resolution

* if CXR normal, refer via Head & Neck pathway
 ** if CXR normal, consider alternative diagnosis including other cancers

 

Refer urgently

Urgent suspicion of cancer referral

  • Any unexplained symptoms or signs detailed above persisting for longer than six weeks despite a normal chest X-ray (other than isolated thrombocytosis or cervical and/or persistent supraclavicular lymphadenopathy)

  • Chest x-ray suggestive/suspicious of lung cancer (including pleural effusion, pleural mass and slowly resolving consolidation)

  • Persistent haemoptysis in smokers/ex-smokersover 40 years of age

Refer via SCI-Gateway...Respiratory...DG-HN Lung Cancer Referral.

It is helpful for follow on imaging to ensure there is a recent FBC and U&E.

It is helpful for a decision on clinic slot to include details on functional level as below to ensure patients are not directly appointed to bronchoscopy when other appointment would be more appropriate.

In people with features suggestive of cancer including suspected metastatic disease, but no other signs to suggest the primary source, consider Early Cancer Detection Clinic referral.

 

Functional capacity

0

Fully active, able to carry on all pre-disease performance without restriction

1

Restricted in physically strenuous activity but ambulatory and able to carry out work of a
light or sedentary nature, e.g., light house work, office work

2

Ambulatory and capable of all selfcare but unable to carry out any work activities. Up
and about more than 50% of waking hours

3

Capable of only limited selfcare, confined to bed or chair more than 50% of waking
hours

4

Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair

Editorial Information

Last reviewed: 29/12/2023

Next review date: 29/12/2025

Author(s): Yvonne Scott.