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. Patients 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 (“2ww”) 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