Signs and symptoms

The following unexplained, persistent signs and symptoms require investigation, if lasting more than 3 weeks (earlier in patients with known risk factors or with more than one sign or symptom):

• new or changed cough
• chest or shoulder pain
• shortness of breath
• hoarseness
• weight loss or loss of appetite
• persistent or recurrent chest infection
• fatigue
• DVT
• abnormal chest signs
• finger clubbing
• cervical or supraclavicular lymphadenopathy
• signs of lung cancer metastasis (e.g. brain, bone, liver or skin)
• pleural effusion
• thrombocytosis.

The following signs and symptoms require urgent referral for a chest CT scan and concurrent referral (within 2 weeks) to a specialist linked to a lung cancer multidisciplinary team:

• persistent or unexplained haemoptysis
• signs of superior vena caval obstruction
• high clinical suspicion of lung cancer
• imaging findings suggesting lung cancer.

The following signs or symptoms require immediate referral to an emergency department:

• massive haemoptysis
• stridor.

GP investigations include:

• a thorough medical history
• urgent chest x-ray for unexplained, persistent symptoms and signs lasting more than 3 weeks (earlier in patients with known risk factors or with more than one symptom or sign) – if the chest X-ray is normal and symptoms persist repeat the chest x-ray at 6 weeks
• chest CT scan if there is a strong clinical suspicion of lung cancer, persistent or unexplained haemoptysis, signs of superior vena caval obstruction or imaging findings suggest lung cancer within 2 weeks of the patient presenting with symptoms. The CT scan should be delivered with contrast unless contraindicated. Concurrently, refer the patient to a specialist linked to a lung cancer multidisciplinary team (consider immediate telephone contact).

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

Communication

The GP’s responsibilities include:

• explaining to the patient and/or carer who they are being referred to and why
• supporting the patient and/or carer while waiting for specialist appointments
• informing the patient and/or carer that they can contact Cancer Council on 13 11 20.

Checklist

Timeframe

Provide test results to the patient within 1 week of presenting to their GP.

The first specialist (linked to a lung cancer multidisciplinary team) appointment should take place within 2 weeks of the initial GP referral.