Tag: thoracic

Lung, Suspicion of Cancer Referral

Scott McLaughlin
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.

Urgent chest x-ray

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.

Urgent suspicion of cancer referral

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.

Urgent suspicion of cancer referral

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

Lung Cancer Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Main Presenting Complaint: [Text – 98 character maximum]

Reason for Referral: [Text]

World Health Organisation Performance Scale
Using the following as a guide, please select the most appropriate answer to describe the patients general health:

Options:

  • Asymptomatic
  • Symptomatic but completely ambulatory
  • Symptomatic, <50% in bed during the day
  • Symptomatic, >50% in bed, but not bedbound
  • Bedbound

What does the patient know: [Text]

Results

Chest X-ray:

  • Normal
  • Abnormal – Suspicion of cancer
  • Abnormal – other

Date of chest x-ray: [Date]

Blood sample for e-GFR taken within past 3 months: 

  • Yes
  • No

Priority: Urgent Suspicion of Cancer

Date of Onset: [Date]

Will the patient accept any site for treatment:

  • Yes
  • No

Lung cancer referral guideline