How should I approach the diagnosis of suspected lung cancer in a pati

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

Approach to diagnosis of suspected lung cancer in a patient with persistent cough and weight loss:

For patients aged 40 and over presenting with an unexplained persistent cough and weight loss, especially if they have a history of smoking or asbestos exposure, offer an urgent chest X-ray to be performed within 2 weeks to investigate possible lung cancer or mesothelioma.
If the chest X-ray shows abnormalities suggestive of lung cancer, proceed with contrast-enhanced CT scanning of the chest, liver, adrenals, and lower neck before any biopsy procedure to assess the extent of disease and staging.
For biopsy, consider image-guided biopsy for peripheral lung lesions or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for paratracheal and peri-bronchial lesions, ensuring samples are adequate for pathological diagnosis, tumour subtyping, and predictive marker assessment.
Offer positron-emission tomography CT (PET-CT) before treatment to all patients who could potentially have curative treatment to aid staging and treatment planning.
Be cautious with contrast medium in patients with known renal impairment.

This approach ensures timely recognition, diagnosis, and staging of lung cancer to facilitate appropriate referral and management.

References: ,

How should I approach the diagnosis of suspected lung cancer in a patient presenting with a persistent cough and weight loss?