Box 1.

National Institute for Health and Care Excellence guidelines for referral of suspected cancer (2005)8

Section 1.3: Lung cancer
Specific recommendations
1.3.2. An urgent referral for a chest X-ray should be made when a patient presents with:

  • haemoptysis, or

  • any of the following unexplained persistent, that is, lasting >3 weeks, symptoms and signs: chest and/or shoulder pain, dyspnoea, weight loss, chest signs, hoarseness, finger clubbing, cervical and/ or supraclavicular lymphadenopathy, cough with or without any of the above, features suggestive of metastasis from a lung cancer, for example, in brain, bone, liver, or skin.


1.3.3. An urgent referral should be made for either of the following:

  • persistent haemoptysis in smokers or ex-smokers who are aged ≥40 years; or

  • a chest X-ray suggestive of lung cancer (including pleural effusion and slowly resolving consolidation).

1.3.4. Immediate referral should be considered for the following:

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

  • stridor.

Referral timelines
The referral timelines used in this guideline are as follows:

  • Immediate: an acute admission or referral occurring within a few hours, or even more quickly if necessary.

  • Urgent: the patient is seen within the national target for urgent referrals (currently 2 weeks).