Before making a referral for suspected lung cancer, the recommended initial investigation is an urgent chest X-ray to be performed within 2 weeks. This is advised for people aged 40 years and over who present with unexplained haemoptysis, or who have two or more unexplained symptoms such as cough, fatigue, shortness of breath, chest pain, weight loss, or appetite loss. Additionally, an urgent chest X-ray is recommended for those aged 40 and over with a history of smoking who have one or more of these symptoms, or those exposed to asbestos with similar symptoms. Persistent or recurrent chest infections, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or thrombocytosis also warrant an urgent chest X-ray before referral NICE NG12,NICE CKS.
Further investigations before referral may include blood tests if clinically indicated, but the primary and essential investigation is the chest X-ray. If the chest X-ray suggests lung cancer, a suspected cancer pathway referral should be made NICE NG12,NICE CKS.