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 (more than 3 weeks) 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 (voice never normal)
    • fatigue
  • New or not previously documented finger clubbing
  • Focal chest signs
  • Chest infection or exacerbation airways disease not responding to 2 courses of antibiotics
  • Persistent supraclavicular lymphadenopathy (3 weeks)*
  • Thrombocytosis where symptoms and signs do not suggest other specific cancer**

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

 

Urgent suspicion of cancer referral

  • Consider referral if concerning symptoms suggesting lung or pleural cancer despite a normal chest X-ray 

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

  • Unexplained haemoptysis (arrange USoC CXR in parallel)

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.