At least ten percent of patients with lung cancer have never smoked.
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
Supraclavicular or axillary lymphadenopathy
Weight loss or constitutional symptoms such as fevers or sweats are worrying features in association with the features above and warrant urgent referral.
Patients with unilateral pleural effusion should be referred urgently to the Pleural Service at Gloucestershire Royal Hospital (contact Dr Steers secretary 03004226564, Fax 03004226519)
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.
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.
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
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.
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%).
Respiratory physicians are happy to provide advice on difficult cases: contact Dr Mark Slade firstname.lastname@example.org or 07733 262506.
2ww Patient Leaflet Ordering
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Palliative Care - Top Tips - GHFT
Please follow the resource link below to the End of Life section for GHFT's top tips for palliative care.