All patients who are suspected of having lung cancer should have a CXR performed first, and the report seen by the referrer, before deciding if a referral to the Respiratory Lung Cancer Clinic is appropriate.
Who to refer:
Referral for Chest x-ray
Refer patients with any of the symptoms below for a chest x-ray via:
Sci Gateway – Clinical Radiology – CXR – “Urgent – Suspected Cancer” and inform the patient that you are making the USOC referral.
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 USOC pathway)
- fatigue in a smoker aged over 40 years
Any unexplained Haemoptysis
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**
* if CXR normal, refer via the ENT Neck lump pathway
** if CXR normal, consider alternative diagnosis including other cancers
How to refer:
CXR reports with findings suspicious of cancer will be emailed by radiology to the Clinical Inbox of the referring GP practice and will require the GP to inform the patient and to send a USOC SCI Gateway referral. It will also be emailed to the appropriate lung cancer clinic. The GP email will contain the following information along with the CXR report:
Dear GP,
URGENT EMAIL, GP ACTION REQUIRED
Please see the report below. I would be grateful if you could inform the patient of the result, warn the patient to expect an urgent appointment and send a formal USOC referral to Respiratory via SCI Gateway:
SCI GATEWAY > SJH or WGH or RIE > Respiratory Medicine > LI Suspected Lung Cancer
This email is being sent to the Practice Clinical Inbox and will also be emailed to the [SJH/WGH/RIE] Lung Cancer Clinic (email address). A SCI GW referral is still needed.
Refer all patients with the following via:
SCI GATEWAY > SJH or WGH or RIE > Respiratory Medicine > LI Suspected Lung Cancer
- Chest x-ray suggestive/suspicious of lung cancer
- Unexplained symptoms or signs detailed in “Who to Refer” persisting for longer than 6 weeks despite a normal chest X-ray (other than isolated thrombocytosis or cervical and/or persistent supraclavicular lymphadenopathy)
- History of haemoptysis in absence of infective symptoms or antibiotic response despite a normal chest x-ray.
Include what the patient has been told about their condition in the referral text.
Good practice points
Take FBC, U&Es and LFTs prior to referral to the Respiratory Lung Cancer Clinic (where possible) in order to expedite further investigations.
Note: a normal chest X-ray does not exclude a diagnosis of lung cancer
There is emerging evidence that thrombocytosis is a risk marker for underlying cancer, including lung. Remember “LEGO-C”
