What are the referral criteria for a patient with suspected lung cancer based on NICE guidelines?

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

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for lung cancer if they have chest X-ray findings that suggest lung cancer .

Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 years and over if they have two or more unexplained symptoms, or if they have ever smoked and have one or more of the following unexplained symptoms: cough, fatigue, shortness of breath, chest pain, weight loss, or appetite loss .

Consider an urgent chest X-ray (to be performed within 2 weeks) in people aged 40 years and over with persistent or recurrent chest infection, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or thrombocytosis .

Refer people with chest X-ray findings that suggest mesothelioma using a suspected cancer pathway referral, and offer an urgent chest X-ray within 2 weeks to assess for mesothelioma in people aged 40 years and over with two or more unexplained symptoms, or one or more symptoms plus a history of smoking or asbestos exposure, or with finger clubbing or chest signs compatible with pleural disease .

Educational content only. Always verify information and use clinical judgement.