Lung cancer referral

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

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 symptoms (3 weeks or longer) 1 or more symptoms for ever smokers or those exposed to asbestos, 2 or more otherwise:
    • change in cough or new cough
    • breathlessness
    • chest/shoulder pain
    • loss of appetite
    • weight loss
    • hoarseness (constant with voice never normal)
    • fatigue
  • New or not previously documented finger clubbing
  • Focal chest signs (e.g. rhonchi, reduced breath sounds or dullness to percussion)
  • Chest infection or exacerbation airways disease not responding to 2 courses of antibiotics
  • Supraclavicular lymphadenopathy*
  • Thrombocytosis where symptoms and signs do not suggest other cause**

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

 

Refer Urgent Suspicion of Cancer

Urgent suspicion of cancer referral

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

  • Unexplained haemoptysis (arrange USoC CXR in parallel but no need to wait for result)

  • Consider referral despite a normal chest X-ray:
    • In smokers:
      • Breathlessness with weight loss or appetite loss
      • Chest pain with weight loss or thrombocytosis

Patients with weight loss and thrombocytosis together or smokers with weight loss and appetite loss should be considered for referral to Rapid Cancer Diagnostic Service

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

It is helpful for follow on imaging to ensure there is a recent (within 3 months) 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 Rapid Cancer Diagnostic Service 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: 01/10/2025

Next review date: 01/10/2027

Author(s): Yvonne Scott.