'red flags' for lung cancer

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Lung cancer is one of the most common malignancies worldwide, but has one of the poorest outcomes as 2/3rds of patients present late with the disease. Given this it is important to be vigilant of the possibility of lung cancer in patients. Patients with lung cancer may present with respiratory symptoms, with worsening chronic disease such as COPD, with symptoms suggestive of malignancy without symptoms specific to the respiratory system, and occasionally with other symptoms which are neither respiratory or point to a malignancy.


NICE guidelines suggests that an urgent chest x ray (within 1 week) should be considered for the following symptoms:

  • Haemoptysis
  • Persistent (+3 weeks) cough
  • Persistent shortness of breath
  • Persistent chest signs
  • Persistent hoarseness
  • Persistent weight loss
  • Persistent clubbing
  • Persistent cervical lymphadenopathy
  • Persistent chest or shoulder pain (think of pancoast tumours)
  • Persistent signs or symptoms suggesting metastases such as bone pain, skin changes, liver changes, or neurological changes. 


A normal chest X-ray does not always rule out the possibility of malignancy

In addition urgent referral to the lung cancer multidisciplinary team should be made if a patient presents with:
  • Smoker over 50 presenting with new haemoptysis
  • Signs and symptoms of superior vena caval obstruction
  • Stridor
Also see the post on lung cancer


http://publications.nice.org.uk/quality-standard-for-lung-cancer-qs17/quality-statement-2-referral-for-chest-x-ray
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3207089/
http://www.rcgp.org.uk/clinical/clinical-resources/~/media/Files/CIRC/Cancer/Improving%20Cancer%20Diagnosis%20-%20A%20Toolkit%20for%20General%20Practice%20(2).ashx


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