Lung Cancer
More than 90% of patients with lung cancer are symptomatic at the time of diagnosis. However, many symptoms associated with lung cancer (particularly cough and fatigue) are common presentations in primary care, associated with chronic diseases such as chronic obstructive pulmonary disease (COPD). It is therefore important that changes in symptoms are identified and acted upon.
Chest x-ray findings are abnormal in over 96% of symptomatic patients with lung cancer. In most cases where lung cancer is suspected, it is appropriate to arrange an urgent chest x-ray before urgent referral to a chest physician. However, a normal chest x-ray does not exclude a diagnosis of lung cancer. If the chest x-ray is normal but there is a high suspicion of lung cancer, patients should be offered urgent referral to a respiratory physician. In patients with a history of asbestos exposure, mesothelioma should be considered.
Any haemoptysis
Unexplained/persistent (more than 3 weeks)
- change in cough
- dyspnoea
- chest/shoulder pain
- weight loss
- chest signs
- hoarseness
- fatigue in a smoker over 50 years
Finger Clubbing
Features suggestive of metastatic disease
Cervical and/or persistent supraclavicular lymphadenopathy
Any person who has been referred for an urgent chest x-ray and has been found with consolidation should have a repeat chest x-ray no more than 6 weeks later to confirm resolution.
Any symptoms or signs detailed above persisting for longer than 6 weeks despite a normal chest x-ray.
Chest x-ray suggestive/suspicious of lung cancer (including pleural effusion, pleural mass and slowly resolving consolidation)
Persistent haemoptysis in smokers/ex-smokers over 50 years of age
Mesothelioma
In mesothelioma, 80 – 90% of patients will have a history of asbestos exposure and it is essential that a career history is taken to identify any possible asbestos exposure.
Individuals over 50 years with history of asbestos exposure and recent onset of:
- chest pain
- dyspnoea
- unexplained systemic symptoms
Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN 137: Management of Lung Cancer
Lead Cancer Clinician: Dr Stuart Baird, Lead Physician for Lung Cancer NHS Lanarkshire
Review Date April 2017