{"id":4101,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/lungcancer\/"},"modified":"2026-02-17T13:16:34","modified_gmt":"2026-02-17T13:16:34","slug":"lungcancer","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/lungcancer\/","title":{"rendered":"Lung Cancer"},"content":{"rendered":"\n<p>All patients who are suspected of having lung cancer should have a CXR performed first. (with the exception of those who present with haemoptysis who should have a CXR requested and an Urgent Suspicion of Cancer (USOC) referral made to Respiratory simultaneously.)<\/p>\n\n\n\n<p>If the CXR is suspicious of lung cancer, the referrer will be informed and asked to make an USOC referral to Respiratory (see under Referral Guidelines tab below)<\/p>\n\n\n\n<p>&nbsp;<strong>Some patients may still be suitable for an Urgent Suspicion of Cancer referral despite a normal CXR (see below)<\/strong><\/p>\n\n\n\n<p>&nbsp;Overlap with other pathways:<\/p>\n\n\n\n<p>&nbsp;Head and neck cancer and lung cancer symptoms overlap (e.g. hoarseness and neck lumps). If the chest x-ray is normal, consider referring according to the Head and neck and thyroid cancer guideline (see <a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer 2025<\/a>) where appropriate.<\/p>\n\n\n\n<p><strong>D.M &amp; P.R 17-02-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p><strong>Referral for Chest x-ray<\/strong><\/p>\n\n\n\n<p>USC chest x-ray should be requested if a person has:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unexplained haemoptysis (refer to respiratory USOC simultaneously) In addition to lung cancer, there are a range of benign causes including infection, bronchiectasis, pulmonary embolism and vasculitis.<\/li>\n\n\n\n<li>Unexplained symptoms lasting three weeks or longer (one or more symptom in an ever-smoker or a person exposed to asbestos, two or more symptoms for all other people):\n<ul class=\"wp-block-list\">\n<li><em>new cough or a change in a cough<\/em><\/li>\n\n\n\n<li><em>breathlessness<\/em><\/li>\n\n\n\n<li><em>chest or shoulder pain<\/em><\/li>\n\n\n\n<li><em>weight loss<\/em><\/li>\n\n\n\n<li><em>loss of appetite<\/em><\/li>\n\n\n\n<li><em>fatigue<\/em><\/li>\n\n\n\n<li><em>hoarseness \u2013 constant with voice never normal<\/em><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Examination findings:\n<ul class=\"wp-block-list\">\n<li><em>focal chest signs (e.g. rhonchi, reduced breath sounds or dullness to percussion)<\/em><\/li>\n\n\n\n<li><em>new or not previously documented finger clubbing<\/em><\/li>\n\n\n\n<li><em>supraclavicular lymphadenopathy<\/em><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>A chest infection or exacerbation of airways disease that does not resolve after two courses of antibiotics<\/li>\n\n\n\n<li>Thrombocytosis where clinical features do not suggest another cause.<strong> <\/strong>Thrombocytosis is a risk marker for malignancy. This especially applies to the \u2018LEGO-C\u2019 group \u2013Lung, Endometrial, Gastric, Oesophageal and Colorectal cancer. For further details see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/thrombocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Thrombocytosis \u2013 RefHelp<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>Refer a person with any of the following to the Respiratory Service as an USOC referral:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Chest x-ray (or CT scan) that is concerning for lung or pleural cancer including unilateral pleural effusion, pleural mass and slowly resolving consolidation.&nbsp; (If the chest x-ray shows consolidation, repeat imaging should be arranged six weeks later to confirm resolution. A USOC referral to respiratory should be made if it remains abnormal.)<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unexplained haemoptysis (arrange a USC chest x-ray but no need to wait for the result prior to referral to the respiratory clinic). Haemoptysis is bleeding arising from below the glottis.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If the chest X-ray is not suspicious for lung or pleural cancer <strong>an USOC referral should still be considered<\/strong> particularly if there are concerning symptom combinations<strong>:<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>In smokers<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Breathlessness with weight loss or appetite loss<\/li>\n\n\n\n<li>Chest pain with weight loss, appetite loss or thrombocytosis<\/li>\n\n\n\n<li>Weight loss and appetite loss together*<\/li>\n<\/ul>\n\n\n\n<p><strong>In all people<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Weight loss and thrombocytosis together*<\/li>\n<\/ul>\n\n\n\n<p>* <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a>, pathway may be a suitable alternative for this symptom combination especially in the absence of respiratory symptoms or a smoking history.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p><strong>For CXR:<\/strong><\/p>\n\n\n\n<p>In the usual way via Sci-Gateway:<\/p>\n\n\n\n<p>RIE or WGH or SJH &gt; Clinical Radiology &gt; LI Radiology Plain X-Ray &gt; select Chest for investigation.&nbsp; Choose priority Urgent Suspicion of Cancer<\/p>\n\n\n\n<p><strong>For Respiratory Medicine<\/strong>: Via Sci-Gateway:<\/p>\n\n\n\n<p>SJH or WGH or RIE &gt; Respiratory Medicine &gt; LI Suspected Lung Cancer<\/p>\n\n\n\n<p>Please arrange bloods including a full blood count (FBC) and renal function if not done in the preceding three months to expedite any further imaging required.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">After Referral:<\/h4>\n\n\n\n<p>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 <strong>inform the patient and to send a USOC SCI Gateway referral.<\/strong> It will also be emailed to the appropriate lung cancer clinic. The email to the GP will contain the following information along with the CXR report:<\/p>\n\n\n\n<p><em>Dear GP,<\/em><\/p>\n\n\n\n<p><strong><em>URGENT EMAIL, GP ACTION REQUIRED<\/em><\/strong><\/p>\n\n\n\n<p><em>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 <\/em><strong><em>send a formal USOC referral<\/em><\/strong><em> to Respiratory via SCI Gateway:<\/em><\/p>\n\n\n\n<p><strong>SCI GATEWAY &gt; SJH or WGH or RIE &gt; Respiratory Medicine &gt; LI Suspected Lung Cancer<\/strong><\/p>\n\n\n\n<p><em>This email is being sent to the <\/em><strong><em>Practice Clinical Inbox<\/em><\/strong><em> and will also be emailed to the [SJH\/WGH\/RIE] Lung Cancer Clinic (email address). <\/em><strong><em>A SCI GW referral is still needed.<\/em><\/strong><\/p>\n\n\n\n<p><strong>Include what the patient has been told about their condition in the referral<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"http:\/\/www.cancerreferral.scot.nhs.uk\/lung-cancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.cancerreferral.scot.nhs.uk\/lung-cancer\/<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.maggies.org\/our-centres\/maggies-edinburgh\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.maggies.org\/our-centres\/maggies-edinburgh<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.macmillan.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.macmillan.org.uk\/<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer 2025<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>All patients who are suspected of having lung cancer should have a CXR performed first. (with the exception of those who present with haemoptysis who should have a CXR requested and an Urgent Suspicion of Cancer (USOC) referral made to Respiratory simultaneously.) If the CXR is suspicious of lung cancer, the referrer will be informed<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4381,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[598],"class_list":["post-4101","page","type-page","status-publish","hentry","category-lungcancer"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/respiratory\/lungcancer\/\" rel=\"tag\">Lung Cancer<\/a>","rttpg_excerpt":"All patients who are suspected of having lung cancer should have a CXR performed first. (with the exception of those who present with haemoptysis who should have a CXR requested and an Urgent Suspicion of Cancer (USOC) referral made to Respiratory simultaneously.) If the CXR is suspicious of lung cancer, the referrer will be informed","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4101","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4101"}],"version-history":[{"count":13,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4101\/revisions"}],"predecessor-version":[{"id":26962,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4101\/revisions\/26962"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4381"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4101"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}