Urgent suspected Lung Cancer

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Lung cancer is a malignant tumour which grows in the tissues of the lung. It is the third most common cancer in the UK with an estimated life time risk of developing lung cancer being 7% for females and 8% for males.

Lung cancer is more commonly diagnosed in people aged 75 and over and is often diagnosed late with 46.1% of new lung cancers in England being stage 4 at diagnosis in 2018.

While over 90% of patients are symptomatic at presentation, symptoms can be vague and similar to other conditions more common in primary care.   

This guideline is aimed at primary care clinicians to provide guidance regarding when to suspect lung cancer, what investigations to perform and when to make a referral to the urgent suspected lung cancer clinic. 

Referral for urgent CXR for suspected lung cancer

Patients presenting with any of the following red flag symptoms/signs for lung cancer should undergo an urgent chest X-ray.

  • Any  unexplained haemoptysis
  • New/ not previously documented finger clubbing
  • Persistent or recurrent chest infection
  • Cervical and/or persistent supraclavicular lymphadenopathy
  • Thrombocytosis, platelets greater than 450 × 109/L where symptoms and signs do not suggest other specific cancer (see thrombocytosis NICE guideline https://cks.nice.org.uk/topics/platelets-abnormal-counts-cancer/)

Any patient who has consolidation on chest x-ray should have a repeat no more than 6 weeks later to confirm resolution regardless of hospital admission or not if:

  • Symptoms/physical signs persist
  • There is higher risk of underlying malignancy
    • smokers
    • aged over 50 years
Investigation

Imaging

  • CXR

Blood tests

  • FBC
  • U&E
  • LFT
  • Calcium

As this is a timed pathway CXR images and blood results must be available at the point of referral in order for the referral to be accepted and progressed appropriately.  If they are not then the referral will be returned.

Referral

Patients meeting any of the following criteria should be referred to the urgent suspected lung cancer clinic.

Chest x-ray suggestive/suspicious of lung cancer including:

  • Lung mass
  • Pleural effusion
  • Pleural mass
  • Slowly resolving consolidation

Despite normal CXR

  • Any of the above unexplained symptoms or signs persisting for more than 6 weeks
  • Persistent haemoptysis in smokers/ex-smokers aged over 40

Alternative referral

Further information for healthcare professionals

Scottish Referral guidelines for suspected lung cancer - http://www.cancerreferral.scot.nhs.uk/lung-cancer/?alttemplate=guideline

Interpreting platelet results | Diagnosis | Platelets - abnormal counts and cancer | CKS | NICE. Revised 2021. Accessed March 3, 2022. https://cks.nice.org.uk/topics/platelets-abnormal-counts-cancer/diagnosis/interpreting-platelet-results/

Coronavirus (COVID-19): management of urgent suspicion of lung cancer referrals https://www.gov.scot/publications/coronavirus-covid-19-management-of-urgent-suspicion-of-lung-cancer-referrals

Symptoms suggestive of lung and pleural cancers | Diagnosis | Lung and pleural cancers - recognition and referral | CKS | NICE. Accessed March 3, 2022. https://cks.nice.org.uk/topics/lung-pleural-cancers-recognition-referral/diagnosis/symptoms-suggestive-of-lung-pleural-cancers/

ENT guideline Horseness: https://tam.nhsh.scot/for-healthcare-professionals/therapeutic-guidelines/ear-nose-and-oropharynx-ent/hoarseness/

Pneumonia Adults | British Thoracic Society | Better lung health for all. 2015. Accessed December 15, 2021. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pneumonia-adults/

Contact the Respiratory Team

For any querys or concerns contact the respiratory consultants for advice: nhsh.raigmorerespiratory@nhs.scot

Patient information
References
  1. Lung cancer incidence statistics | Cancer Research UK. Accessed October 31, 2021. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/incidence#heading-Zero
  2. CR S, KA P, K S, N M. Cancer incidence and mortality projections in the UK until 2035. Br J Cancer. 2016;115(9):1147-1155. doi:10.1038/BJC.2016.304
  3. Early Diagnosis. Accessed October 31, 2021. https://crukcancerintelligence.shinyapps.io/EarlyDiagnosis/
  4. Lung Cancer. 2019. Accessed October 31, 2021. http://www.cancerreferral.scot.nhs.uk/lung-cancer/?alttemplate=guideline
  5. Pneumonia Adults | British Thoracic Society | Better lung health for all. 2015. Accessed December 15, 2021. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pneumonia-adults/

  6. Interpreting platelet results | Diagnosis | Platelets - abnormal counts and cancer | CKS | NICE. Revised 2021. Accessed March 3, 2022. https://cks.nice.org.uk/topics/platelets-abnormal-counts-cancer/diagnosis/interpreting-platelet-results/

Glossary

CXR – Chest Xray

ENT- Ear, Nose and Throat

FBC- Full blood count

U&E- Urea and electrolytes

LFT – Liver function Tests

Editorial Information

Last reviewed: 30 April 2022

Next review: 30 April 2025

Author(s): Specialty Respiratory Research Doctor

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Specialty Respiratory Research Doctor

Document Id: TAM494