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

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.

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