Lung Cancer: Referral

Question 1

When should an immediate referral be made?

Answer 1

• When there are signs of superior vena cava obstruction (Swelling of face/neck, superficially prominent veins - Pemberton’s sign positive)
• Stridor

Question 2

When should a patient be referred urgently?

Answer 2

• Persistent haemoptysis (in smokers or ex-smokers aged 40 years and older)
• A chest X-ray suggestive of lung cancer (including pleural effusion and slowly resolving consolidation)
• A normal chest X-ray where there is a high suspicion of lung cancer
• A history of asbestos exposure and recent onset of chest pain, shortness of breath or unexplained systemic symptoms where a chest x-ray indicates pleural effusion, pleural mass or any suspicious lung pathology

Question 3

When should you refer a patient urgently for a CXR?

Answer 3

• Haemoptysis
• Unexplained or persistent (longer than 3 weeks):
  
  • Chest and/or shoulder pain
  • Dyspnoea
  • Weight loss,
  • Chest signs
  • Hoarseness
  • Finger clubbing
  • Cervical or supraclavicular lymphadenopathy
  • Cough
  • Features suggestive of lung cancer (e.g. secondaries to bone, brain, liver, skin)
  • Underlying chronic respiratory problems with unexplained changes in their condition.

Question 4

If you see a patient with a normal CXR but they have SOB, a low Hb, Weight loss and hyponatramia, what should you do?

Answer 4

Investigated on an urgent basis of lung cancer.

The low sodium could be from an SIADH secreting tumour.

Whilst gastrointestinal cancer is a possibility for a low Hb a normal MCV is not entirely consistent with chronic GI blood loss.