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Should I see a lung specialist?

Men and women discussing lung cancer

This page tells you about the guidelines that UK GPs have to help them refer people appropriately for lung cancer tests. There is information about

 

A quick guide to what's on this page

Should I see a lung specialist?

The symptoms of lung cancer can be very similar to symptoms of other less serious conditions. So it can be very difficult for GPs to decide who might have a cancer and who may have something more minor. The National Institute for Health and Care Excellence (NICE) has produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist.

When you might need an urgent chest X-ray

You should have an urgent chest X-ray if you cough up blood, have blood in your phlegm, or have any of the following symptoms for longer than 3 weeks with no apparent cause

  • A cough (with or without any of these other symptoms)
  • Pain in the shoulder or chest
  • Difficulty breathing or a hoarse voice
  • Marked loss of weight
  • Enlarged lymph nodes in your neck or above your collarbone
  • Thickening and broadening of the fingertips, called clubbing
  • Unexplained changes to symptoms from existing lung disease

Guidelines for urgent or immediate referral

You should see a specialist urgently (ideally within 2 weeks) if 

  • Your chest X-ray has signs suspicious of lung cancer
  • You are an ex smoker or a smoker over 40 coughing up blood
  • You have a history of asbestos exposure and have recently started to get chest pain and shortness of breath. 

You need to see a specialist straight away if you have 

  • Swelling of your face and neck and higher than normal pressure in your jugular veins or
  • A particular type of very noisy breathing called stridor

Both of these effects are very rare. 

 

CR PDF Icon You can view and print the quick guides for all the pages in the About lung cancer section.

 

 

UK referral guidelines

The symptoms of lung cancer can be very similar to symptoms of other less serious conditions. So it can be very difficult for GPs to decide who may have a cancer and who may have something much more minor that will go away on its own. 

With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed. People needing urgent appointments wouldn't then be able to get them.

GPs have guidelines from the National Institute for Health and Care Excellence (NICE) to help them decide which patients need to be seen urgently by a specialist. There are particular symptoms that mean your GP should refer you to a specialist straight away. 

The guidelines say that with certain symptoms your doctor should send you for an urgent chest X-ray. If the X-ray shows anything abnormal, then you need to see a specialist. Some symptoms need a referral to a chest specialist and you should see the specialist within two weeks of going to the GP. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) has produced very similar guidelines.

 

Who needs an urgent chest X-ray

If you cough up blood or have blood in your phlegm (sputum) you should have an urgent chest X-ray.

You should also have an urgent chest X-ray if you have any of the following symptoms for more than 3 weeks with no apparent cause.

  • A cough (with or without any of these other symptoms)
  • Pain in the shoulder or chest
  • Difficulty breathing
  • Marked loss of weight
  • A hoarse voice
  • Enlarged lymph nodes in your neck or above your collarbone
  • A particular type of thickening and broadening of the fingertips, called clubbing
  • Unexplained changes to symptoms from an existing chronic breathing problem or lung disease
  • Other signs that may make your GP suspect you have a cancer that has spread
 

Guidelines for urgent referral

According to the NICE guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. You should ideally see a specialist urgently if you have

  • A chest X-ray that has signs suspicious of lung cancer, with or without other unexplained symptoms
  • Coughing up blood that does not get better and you are an ex smoker or a smoker over 40
  • A history of asbestos exposure, and you have recently started getting chest pain and shortness of breath
 

Guidelines for immediate referral

Your GP should refer you to a specialist straight away if you have either of these symptoms

  • Swelling of your face and neck and higher than normal pressure in your jugular vein
  • A particular type of very noisy breathing, called stridor

Swelling of the face and neck with raised pressure in the jugular vein is called superior vena cava obstruction (SVCO). The swelling happens when the normal blood flow is partly blocked because the veins in the area are being squashed. The blockage can sometimes be caused by a tumour. The pressure from the blockage makes fluid leak out of the vein and causes swelling in the face and neck.

Both of these effects are very rare.

 

Are symptoms likely to be lung cancer?

Most lung cancers are diagnosed in people older than 60. Only 1 in every 100 is in someone younger than 40. Your GP may be more likely to ask you to have a chest X-ray or see a specialist if you

  • Smoke, or have smoked in the past
  • Have a smoking related lung disease, such as chronic obstructive pulmonary disease (COPD)
  • Have been exposed to asbestos
  • Have had another cancer in the past, especially in the head and neck area

Your doctor may refer you to a specialist even if you have had symptoms for less than 3 weeks.

If you are worried that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you. Then you may be able to decide together whether you need to see a specialist and if so, how soon.

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Updated: 27 March 2014