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

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.

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