How should I assess a patient with persistent cough and weight loss fo

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Assessing a patient with persistent cough and weight loss for potential lung cancer involves the following steps:

Age and risk factors: Confirm if the patient is aged 40 years or over and assess smoking history or asbestos exposure, as these increase lung cancer risk.
Symptom evaluation: Identify if the cough is unexplained and persistent, and if weight loss is unexplained. Also assess for associated symptoms such as fatigue, shortness of breath, chest pain, or appetite loss.
Physical examination: Perform a respiratory examination looking for chest signs consistent with lung cancer, finger clubbing, or lymphadenopathy.
Urgent chest X-ray: Offer an urgent chest X-ray to be done within 2 weeks if the patient is 40 or over with unexplained persistent cough and weight loss, especially if they have ever smoked or have other symptoms like fatigue or chest pain.
Referral: If chest X-ray findings suggest lung cancer, or if the patient has unexplained haemoptysis aged 40 or over, refer urgently via the suspected cancer pathway for assessment within 2 weeks.

This approach ensures timely investigation and referral for lung cancer in patients presenting with persistent cough and weight loss.

How should I assess a patient with persistent cough and weight loss for potential lung cancer?