Getting diagnosed
It can be hard for GPs to decide who may have cancer and who might have a more minor condition. For some symptoms, your doctor may ask you to wait to see if the symptoms get better or respond to treatment, such as antibiotics.
But there are certain symptoms, which could be caused by pleural mesothelioma, that mean your GP should send you for an urgent chest x-ray or refer you to a specialist.
There are guidelines for GPs to help them decide who needs a referral. These vary slightly between the different UK nations. Your GP will use these guidelines as well as their own experience and judgement.
The guidance below is based on the National Institute for Health and Care Excellence (NICE) guidelines for England and Wales.
Your GP should offer you an urgent appointment for a chest x-ray (within 2 weeks) if you are aged 40 or over and have 2 or more of the unexplained symptoms on the following list. Or, if you have a history of smoking or previous exposure to asbestos and you have 1 or more of the following unexplained symptoms:
a cough
tiredness (fatigue)
shortness of breath
chest pain
weight loss
loss of appetite
Your GP should consider offering you an urgent appointment for a chest x-ray (within 2 weeks) if you are aged 40 or over and have:
changes in the shape of your fingers and nails called finger clubbing
chest symptoms that could indicate lung disease, such as a cough, shortness of breath or chest pain
You should have an urgent referral to see a specialist if:
your chest x-ray shows changes that could be due to mesothelioma
In Scotland the guidance groups together the symptoms of lung and cancers.
Your GP should refer you urgently to a specialist if you:
have had a chest x-ray or CT scan that has changes that could be due to lung or pleural cancer
are coughing up blood for no reason – your GP will also refer you for an urgent chest x-ray
If you have already had a chest x-ray which doesn’t show any possible lung or pleural cancer signs, your GP should still refer you urgently to a specialist if you:
are a smoker and you are breathless and have weight loss or appetite loss
are a smoker and you have chest pain with weight loss, appetite loss or a high count in your blood (thrombocytosis)
are a smoker and you have weight loss and appetite loss together
are a smoker or non smoker and you have weight loss and thrombocytosis together
In some of these cases your GP might refer you:
to a Rapid Cancer Diagnostic Service (RCDS) instead of a lung specialist – this service aims to speed up investigations for people with symptoms that could be cancer
directly to have a instead of to a lung specialist
Your GP should refer you for an urgent chest x-ray if you have any of the following symptoms. You:
are coughing up blood for no reason
have a new thickening and broadening of the fingertips, called finger clubbing
have specific lung sounds when your health professional examines you and listens to your chest
have enlarged above your collarbone
have thrombocytosis and signs do not suggest a cause other than lung or pleural cancer
have a chest infection which doesn’t get better after 2 courses of
have worsening of any of your usual breathing problems, which don’t get better after 2 courses of antibiotics
You should also get an urgent chest x-ray if you have had one or more of the following symptoms for 3 weeks or more and there is no obvious cause. You have:
a new cough or change in cough
breathlessness
chest or shoulder pain
weight loss
loss of appetite
been feeling very tired (fatigue)
a constant hoarse voice and your voice is never normal
If you’ve smoked or been exposed to you should have a referral with one symptom.
For people who have never smoked or been exposed to asbestos, you should have a referral if you have 2 or more symptoms.
If certain changes are picked up on your x-ray, you should have a further x-ray 6 weeks later to find out if it has cleared up. These changes show as a white area on the x-ray. This white area is also called consolidation. It can be caused by a number of conditions not just cancer.
You should have an urgent referral if the x-ray still shows these changes.
Northern Ireland do not have specific referral guidelines for mesothelioma.
There are no guidelines for seeing a specialist for peritoneal mesothelioma. If you know that you have been exposed to asbestos in the past and you have unexplained symptoms in your tummy (abdomen), you should see your GP.
Read more about symptoms of peritoneal mesothelioma
Your GP will consider any other symptoms that you are having, so do mention these. They might also take into account whether you have any risk factors that affect your chances of developing mesothelioma.
Sometimes you might feel that your GP is not concerned enough about your symptoms. If you think they should be more concerned, print this page and the symptoms page and talk it through with your GP. Ask them to explain why they don’t think you need a referral.
If your GP has referred you, ask them when you should get your appointment. Contact them again if you don’t get one. Or some hospitals have a referral service you could try contacting if you know which hospital you are going to. Explain that you are waiting for an urgent suspected cancer referral
Go to more information about an urgent referral, what to expect and questions to ask
Your hospital is working towards waiting time targets. For example, a target to find out whether you have cancer or not. And there are targets to start treatment if you are diagnosed with cancer. These are slightly different depending on where you live in the UK.
Last reviewed: 19 May 2023
Next review due: 19 May 2026
Mesothelioma can be difficult to diagnose. You usually have a number of tests to check whether your symptoms are due to mesothelioma. Once mesothelioma is diagnosed, you have further tests to find out how big the tumour is and whether it has spread.
You usually start by seeing your GP who might refer you to a specialist. Or you might go to Accident and Emergency (A&E) if you suddenly have severe symptoms.
The treatment you have depends on the stage and type of your mesothelioma. Some people with early stage mesothelioma have surgery. Other treatments include immunotherapy, chemotherapy and radiotherapy.
Mesothelioma is a cancer that most commonly starts in the layers of tissue that cover each lung (the pleura). Read more about how common it is, what it is and who gets it.
Mesothelioma is a cancer that most commonly starts in the sheets of skin-like tissue that cover each lung (the pleura). More rarely it starts in the sheet of tissue in the abdomen that covers the digestive system organs (the peritoneum).
Finger clubbing means there are changes in the shape of your fingers and fingernails. It is also called digital clubbing or Hippocratic fingers. People with heart or lung problems sometimes have these changes.
About Cancer generously supported by Dangoor Education since 2010. Learn more about Dangoor Education
Search our clinical trials database for all cancer trials and studies recruiting in the UK.
Connect with other people affected by cancer and share your experiences.
Questions about cancer? Call freephone 0808 800 40 40 from 9 to 5 - Monday to Friday. Alternatively, you can email us.
