Referral to a specialist for symptoms of lung cancer

Your GP should arrange for you to see a specialist or have tests if you have symptoms that could be due to lung cancer. Depending on your symptoms and other factors, this might be an urgent referral.

You will see a specialist or have tests as soon as possible. Ask your GP when this is likely to be.

Seeing your GP

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.

Your GP might arrange for you to have some tests first. This will help them decide if you need to see a specialist.

UK referral guidelines

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.

England and Wales

You should get an urgent appointment for an x-ray (within 2 weeks) if you are over 40 and have 2 or more of these symptoms or if you have ever smoked, or have had previous exposure to asbestos and have 1 or more of these symptoms:

• a cough most of the time, including coughing up blood for no reason
• tiredness and weakness (fatigue)
• shortness of breath
• chest pain
• weight loss
• loss of appetite

Your GP should consider referring you for an urgent chest x-ray (within 2 weeks) if you are over 40 and have any of these:

• an ongoing or recurrent chest infection
• a particular type of thickening and broadening of the fingertips, called finger clubbing
• swollen (enlarged) lymph nodes in your neck or above your collarbone
• chest symptoms such as a cough, shortness of breath or chest pain
• a high platelet count in your blood (thrombocytosis)

You should have an urgent referral to see a specialist if you:

• have a chest x-ray that shows changes that could be due to lung cancer
• are aged 40 or over and are coughing up blood

Scotland

Your GP should refer you urgently to a specialist if you:

• have a chest x-ray or CT scan that has changes that could be due to lung 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 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 platelet 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 CT scan 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 lymph nodes in your neck or above your collarbone
• have thrombocytosis and signs do not suggest a cause other than lung cancer
• have a chest infection which doesn’t get better after 2 courses of antibiotics
• 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 more than 3 weeks 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 asbestos 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

Your GP should refer you immediately if you have:

• swelling of the face or neck - this could be a sign of a blockage of a large vein to the heart (superior vena cava obstruction)
• noisy breathing caused by a blockage or narrowing of the airway (stridor)

Your GP should refer you for an urgent chest x-ray if you:

• cough up blood
• have an underlying chronic breathing problem with unexplained changes in symptoms

You should also get an urgent chest x-ray if you have any of the following symptoms for more than 3 weeks or there is no obvious cause:

• chest or shoulder pain
• difficulty breathing
• weight loss
• chest signs
• hoarseness
• a type of thickening and broadening of the fingertips, called finger clubbing
• enlarged lymph nodes in your neck or above your collarbone
• a cough

Your GP should refer you urgently to a specialist if you:

• are a smoker or ex smoker aged 40 years or older and are coughing up blood and it’s not getting better (persistent haemoptysis)
• have had a chest x-ray that shows you might have lung cancer
• have had a normal chest x-ray but your GP thinks you might have lung cancer
• have a history of being in contact with asbestos and recently started to have chest pain, or shortness of breath, or unexplained symptoms and have an abnormal x-ray

Other symptoms

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 lung cancer.

What should I do if I don’t get my appointment?

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

Waiting times

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.