Top tips in lung cancer
  1. At least ten percent of patients with lung cancer have never smoked.
  2. New, persistent symptoms or signs in smokers or ex-smokers should lead to a chest X-ray and referral via the lung cancer 2-week wait, e.g.
    • Cough for more than 3 weeks
    • Haemoptysis
    • Monophonic wheeze
    • New clubbing
    • Supraclavicular or axillary lymphadenopathy
    • Pleural effusion
  3. Weight loss or constitutional symptoms such as fevers or sweats are worrying features in association with the features above and warrant urgent referral.
  4. Patients with unilateral pleural effusion should be referred urgently to the Pleural Service at Gloucestershire Royal Hospital (contact Dr Steers secretary 03004226564, Fax  03004226519)
  5. Patients with stridor or signs of superior vena caval obstruction should be admitted via 999 and Single Point of Clinical Access, preferably also discussed urgently with the respiratory physician on call.
  6. Patients referred with suspected lung cancer will require an urgent CT scan of the chest and upper abdomen with i.v. contrast.  To avoid the risk of contrast nephropathy, we require a serum creatinine estimation within the past 3 months prior to CT scan and it is very helpful if a recent result can be included with the referral, or otherwise if confirmation can be provided that a blood test has been sent. It is useful to request a CT Chest at the time of the 2WW Lung referral.
  7. If a chest X-ray demonstrates an abnormality in a patient fulfilling the criteria in point 2 above, a 2-week wait referral is indicated without waiting for a follow-up CXR in 4-6 weeks
  8. Sputum cytology is not a helpful test except in patients who are not fit for other investigations.  The decision on whether a patient is fit for an investigation should be taken by a consultant with extensive experience of that investigation as often patients of borderline respiratory reserve can benefit from treatment for lung cancer.
  9. Patients with transient haemoptysis in the setting of a chest infection, who have a normal CXR, have a low probability of having lung cancer (c. 1%).
  10. Respiratory physicians are happy to provide advice on difficult cases: contact Dr Mark Slade or 07733 262506.
GP Chest X-rays - improving access to CT when there is suspicion

As part of the move towards the nationally described optimal lung cancer pathway, as of Monday 14th May there will be changes to how GHFT’s radiology teams handle GP referred CXR. These changes will speed up access for CT scans so that the right patients can be access important treatment sooner.

  1. All patients attending for a CXR need to be informed that they may be recalled for a CT scan if there is anything on the CXR that needs further clarification.  Patient will be given leaflets explaining this when they attend for the CXR, but GPs should also inform them of this process at the point the Xray is requested. 
  2. All CXRs will be reviewed immediately within the radiology department
  3. For patients whose Xrays are concerning for malignancy (CX3 code)
    1. Radiology will automatically recall patient for CT scan within 7 days
    2. Report will be sent back to GP with findings and instructions.  On receipt of report GP should send fast track 2ww referral through ERS and will be able to book into a next day ‘virtual clinic’.  GP to contact patient to explain that they are being referred on a suspected lung cancer pathway.  Urgent U+E will also be required if not performed in last 3 months to enable contrast CT to be performed.
    3. Lung cancer team will review referrals in virtual clinic daily and will arrange urgent 2ww appointment after CT scan.
  4. For patients with abnormal CXRs with low concern for malignancy (CX2 code)
    1. Where CT is required for clarification, this will be arranged directly by radiology and report will go back to GP advising them to wait for the result before taking further action.
    2. Where result requires clinical correlation (eg probable infection) then report will go back to GP with advice, eg repeat CXR in 6-8 weeks.
  5. Where CXR is not concerning for malignancy (CX1 code) then report will go back to GP as usual

Historically GPs would have to receive a CXR report, make a clinical decision and then request a CT. These changes will take out some wasteful duplication in the pathway and will save days from the lung cancer pathway, helping our patients access the 62 cancer quality standard (from referral to treatment).

This is not the only mechanism of 2ww referrals, individuals can still be referred through the normal route if there is strong clinical concern.  In order for the patient experience to be optimised it is important that when a GP requests an x-ray the patient is prepared that a CT may follow if further investigation is required. It is also vital that if you are suspicious of Cancer this conversation is had at point of referral.

For any further information please contact

2ww Patient Leaflet Ordering

If you would like to order copies of the GCCG 2WW Patient Leaflet, please email your request to or alternatively contact the Cancer Clinical Programmes Team via reception on 0300 421 1500.

Palliative Care - Top Tips - GHNHSFT

Please follow the resource link below to the End of Life section for GHNHSFT's top tips for palliative care.

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