Criteria for Urgent Chest X-Ray (at least one MUST be applicable)

40 or over, never smoked, but 2 or more of the following, or;
40 or over and previously smoke, with 1 or more of the following, or;
Any age with asbestos exposure and 1 or more of the following:

  • Cough
  • Fatigue
  • Shortness of breath
  • Chest pain
  • Weight loss
  • Appetite loss
  • Persistent or recurrent chest infection
  • Finger clubbing
  • Supraclavicular lymphadenopathy
  • Persistent cervical lymphadenopathy
  • Thrombocytosis
Criteria for Urgent Referral (at least one MUST be applicable)
  • CXR Findings suggest lung cancer or mesothelioma
  • ≥ 40 with unexplained haemoptysis
Useful Guidance
  • Patients waking with blood in their mouth or on their pillow – although this is often called haemoptysis, it is very rarely anything to do with the lungs, and an ENT referral is usually more appropriate.
  • When radiologists report consolidation and suggest to repeat the CXR after a few weeks this is usually for a good reason and referring in to the lung cancer service often leads to an unnecessary or unhelpful CT scan, so try and follow this advice unless you are really worried.
  • Weight loss in a smoker with a normal CXR probably should go through the CUP / Non Site-Specific Pathway.

If referring someone for high suspicion of lung cancer, please advise they may be recalled for a CT scan by the hospital, and print patient leaflet.

How to Differentiate Lung Cancer from COVID-19

Significant Weight Loss Only?

Non Site-Specific Pathway