Urgent referral to a chest physician

Any of the following should be referred for urgent specialist review (2 week referral):

• have chest X-ray findings that suggest lung cancer (1)
• unexplained haemoptysis in patients over 40 years of age (1)

NICE state that if a chest X-ray or chest computed tomography (CT) scan suggests lung cancer (including pleural effusion and slowly resolving consolidation), patients should be offered an urgent referral to a member of the lung cancer multidisciplinary team (MDT), usually a chest physician (2).

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for mesothelioma if they have chest X-ray findings that suggest mesothelioma (1).

Consider emergency/immediate referral for patients with (2,3):

• signs of superior vena caval obstruction (swelling of the face/neck with fixed elevation of jugular venous pressure)
• stridor

Reference:

1. NICE (June 2015). Suspected cancer: recognition and Suspected cancer: recognition and referral.
2. NICE (February 2011). Lung cancer - the diagnosis and treatment of lung cancer
3. NICE (June 2005). Referral Guidelines for Suspected Cancer