Lung 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


REFERRAL GUIDELINES FOR SUSPECTED LUNG CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggestive of lung cancer as detailed in the NICE guidance below.
  • Only refer when patient is available to attend an appointment within the next 14 days.



  • All Patients being referred as USC should have had a recent CXR
  • Consider IMMEDIATE referral for patients with signs of Superior Vena Caval Obstruction or Stridor
  • The following blood tests must have been done in the last 6 weeks (FBC, U&E, eGFR Ca & LFT and INR/clotting

Please refer to NICE referral guidelines for suspected cancer


Referral Criteria

Immediate referral as an emergency:

  • Patients with signs of Superior Vena Caval Obstruction (swelling of the face/neck with fixed elevation of jugular venous pressure) or Stridor

Urgent 2ww:

  • Unexplained haemoptysis (in smokers or ex-smokers aged 40 years and older)
  • A chest X-ray suggestive of lung cancer (including pleural effusion and slowly resolving consolidation)
  • A normal chest X-ray where there is a high suspicion of lung cancer
  • A history of asbestos exposure and recent onset of chest pain, shortness of breath or unexplained systemic symptoms where a chest X-ray indicates pleural effusion, pleural mass or any suspicious lung pathology

Urgent Chest X-ray

  • Refer urgently for chest X-ray (the report should be returned within 5 days) for patients with any of the following:
  • Haemoptysis
  • Unexplained or persistent (longer than 3 weeks):
    • chest and/or shoulder pain
    • dyspnoea
    • weight loss
    • persistent or recurrent chest infections
    • hoarseness
    • finger clubbing
    • cervical or supraclavicular lymphadenopathy
    • cough
    • features suggestive of metastasis from a lung cancer (for example secondaries in the brain, bone, liver, skin)
    • thrombocytosis
  • Underlying chronic respiratory problems with unexplained changes in existing symptoms

Risk factors:

  • The following patients have a high risk of developing lung cancer:
    • All current or ex-smokers
    • Patients with chronic obstructive pulmonary disease
    • People who have been exposed to asbestos
    • People with a previous history of cancer (especially head and neck)
  • An urgent referral for a chest X-ray or to a specialist can be considered sooner in these patients (for example if signs and symptoms have lasted less than 3 weeks).

Referral Instructions

Supporting Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 02.2020
  • Ref No: CA8 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to:
Only the electronic version is maintained, once printed this is no longer a controlled document


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