Lung cancer - information for referrers

Lung Cancer Pathway  

Referral route  

Urgent Suspected Lung Cancer ( “ 2WW ” ) referrals should be  submitted  electronically at the time of consultation .  P atients should not leave the surgery without a clear plan. ​ ​  

Telephone and face-to-face clinic appointments are available. Requirement for investigations (e.g. CT chest if  not already  performed) and clinic format will be  determined  during lung cancer consultant triage. ​  

​The lung cancer service will triage referrals within 24 hours and coordinate rapid investigation in line with  the National  Optimal Lung Cancer Pathway. ​  

Patients with TB, chronic cough, or other respiratory symptoms with a normal CT or CXR and no  clinical concern for malignancy should be referred to the TB clinic (direct booking available) or the General  Respiratory Clinic , as  appropriate , and not via the lung cancer pathway. ​ ​  

Do not use the USC pathway for patients requiring same-day emergency admission or urgent  acute assessment , including suspected: ​

  • superior vena cava (SVC) obstruction
  • stridor or airway compromise ​  

Possible procedures  on typical  USC ( “ 2 ww” )  pathway  

  • Low-dose non-contrast CT chest (default  initial  investigation) ​
  • Staging CT with contrast as indicated
  • PET-CT ​
  • Pleural aspiration ± pleural biopsy ​
  • Ultrasound-guided lymph node biopsy
  • Image-guided lung biopsy ​
  • Bronchoscopy
  • Endobronchial ultrasound (EBUS) ​
  • Lung function testing
  • Blood tests ​  

The lung cancer team will explain, coordinate, and prioritise investigations to maximise diagnostic and staging yield while minimising delay and patient harm. ​  

Essential tests prior to referral  

There are  no mandatory tests   required  prior to referral for patients at  high risk  of lung cancer. ​  

Patients considered  high risk  (based on clinical judgement, including those aged ≥40 years who are current or former smokers, particularly with haemoptysis, weight loss, or persistent unexplained symptoms) should be referred directly on the  urgent suspected cancer (“ 2WW ”)  pathway. ​  

​A chest radiograph should be requested  in parallel, but referral should not be delayed while awaiting results. ​  

​For patients who are not  high risk , GPs are strongly encouraged to use the Direct Access CT Chest pathway - https://gps.cityandhackneyccg.nhs.uk/service/direct-access-ct-chest ​
 

Optional tests (concurrent to referral) or other useful information  

FBC, U&Es, LFTs, CRP, Clotting are helpful blood tests to have in advance of the first clinic appointment, and we would be grateful if you could arrange these​ .   

Things the hospital or patient need to know  

In keeping with the urgency of this pathway, we usually obtain an urgent CT scan, if not already arranged by the referrer. If you have not been able to  arrange a  CT scan before the referral, to expedite  this, please let us know if the patient has