Lung and pleural cancer referral guidelines

Read our lung and pleural cancer referral guidelines, which can help you with clinical decision making.

About these guidelines

We have developed our Rapid Referral Guidelines to support GPs with practical referral recommendations for children, young people and adults with symptoms of suspected cancer. The guidelines are endorsed by NICE and summarise the NG12 guidelines for suspected cancer. They can help you decide if a referral is:

Non urgent

Non urgent

Requires routine referral or tests.



Required within two weeks.

Very urgent

Very urgent

Required within 48 hours.

We have recommendations on patient support, safety netting and the diagnostic process.

You can also download a copy of the guidelines (PDF).

Lung cancer referral guidelines

Very urgent

Urgent referral

Urgently refer people (appointment within two weeks) if:

  • chest X-ray findings suggest lung cancer or mesothelioma
  • OR they’re aged 40 or over and have unexplained haemoptysis.
Very urgent

Urgent investigations

Consider an urgent chest X-ray (to be performed within two weeks) for lung cancer or mesothelioma in people aged 40 or over with any of the following:

  • persistent or recurrent chest infection
  • finger clubbing
  • supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  • chest signs consistent with lung cancer or pleural disease
  • thrombocytosis.
Very urgent

Urgent investigation

Offer an urgent chest X-ray (to be performed within two weeks) to the following people to assess for lung cancer or mesothelioma:

  • aged 40 or over who have never smoked and display two or more of the unexplained signs or symptoms listed below:
    • OR aged 40 or over who have previously smoked and display one or more of the unexplained signs or symptoms listed below:
    • OR of any age who have been exposed to asbestos and display one or more of the signs or symptoms listed below:
      • cough
      • fatigue
      • shortness of breath
      • chest pain
      • weight loss
      • appetite loss.

Lung and plural accompanying notes

A normal chest X-ray does not exclude the possibility of a lung cancer diagnosis. This was shown in a large British Journal of General Practice study conducted in 2006.

It revealed that 23% of chest X-rays done in a primary care setting for people with lung cancer were negative when performed within a year of diagnosis.

Glossary of terms

In these guidelines, we use the below terms in the way they are described.

This is consistent with NICE's NG12 guidance for suspected cancer.

  • Children – from birth to 15 years.
  • Young people – people aged 16–24.
  • Direct access – when a test is performed and primary care retain clinical responsibility throughout, including acting on the result.
  • Immediate – an acute admission or referral occurring within a few hours, or even more quickly, if necessary.
  • Suspected cancer pathway referral – the patient is seen within the national target for cancer referrals (two weeks at the time of publication of the 2015 NICE guidance).

Legal disclaimer

Please note, these guidelines aim to share learning and good practice but, out of necessity, they are brief in nature. They are not a substitute for your own clinical judgement or advice provided to you by a specialist.

Macmillan and NICE will not accept any liability for any type of loss caused by someone acting on information contained in the guidelines, unless liability is enforced by law.