21st February 2025

Presentation of lung cancer

Lung cancer is often picked up at an asymptomatic stage via imaging; symptoms can indicate advanced disease. The most common presenting symptoms are cough, haemoptysis, dyspnoea and chest pain. Signs on imaging include lung nodules, hilar enlargement, lobar collapse and pleural effusions.

The NICE suspected cancer referral guidelines for lung cancer are as follows:

Two week wait referral	Urgent CXR	Consider urgent CXR
CXR suspicious for lung cancer OR Age ≥40 with unexplained haemoptysis	Age ≥40 with 2 of these features, or smoking history with 1 feature: Cough Fatigue Dyspnoea Chest pain Weight loss Appetite loss	Age ≥40 and any of the following: Persistent/recurrent chest infection Finger clubbing Supraclavicular or persistent cervical lymphadenopathy Chest signs consistent with lung cancer Thrombocytosis

Two week wait referral

Urgent CXR

Consider urgent CXR

CXR suspicious for lung cancer

Age ≥40 with unexplained haemoptysis

Age ≥40 with 2 of these features, or smoking history with 1 feature:

Cough

Fatigue

Dyspnoea

Chest pain

Weight loss

Appetite loss