GP Update

Best practice for diagnosing lung cancer

Lung cancer symptoms can easily be confused with those of chronic obstructive pulmonary disease (COPD).

11 December 2018

The main problems when it comes to diagnosing lung cancer are:

  • Many people with lung cancer do not have symptoms until their disease is at an advanced stage
  • The symptoms of lung cancer are similar to those of COPD
  • The risk factors for lung cancer are similar to the risk factors for COPD.
  • Chest X-rays

Although most large lung cancers can be seen on a chest X-ray, a study in the British Journal of General Practice in 2006 showed that 23 per cent of results come back negative when they shouldn’t be.

Be aware of false negative chest X-rays. If a chest X-ray is negative, but there is still clinical suspicion, either refer the patient for a computed tomography (CT) scan (if available), or refer the patient via a suspected cancer pathway.

Blood tests

Blood tests can be helpful. For example, thrombocytosis is associated with increased risk of cancer, particularly lung and colorectal cancer, so a raised platelet count can be a cause for concern.

Lung cancer is also a frequently missed cause of anaemia, so haemoglobin levels can also be important.

Screening questions

It is important to run through a series of questions with patients to assess the risk of lung cancer, for example, how long have they had a cough and has it been getting worse, have they been short of breath, have they lost weight, have they had any chest pains, is it impacting their quality of life? Patients may not volunteer all the relevant information without being prompted, for example what impact their symptoms are having on their daily life, weight loss and haemoptysis.

Asking a series of questions during the appointment will help with the decision about whether to refer the patient. 

Patients with concerning symptoms should be offered a chest X-ray and/or suspected cancer referral, in line with NICE guidelines.

GatewayC – online education platform for primary care

An online cancer education platform has been developed for GPs, practice nurses and other primary care professionals with the aim of improving cancer outcomes by facilitating earlier and faster diagnosis.

GatewayC has been piloted by GPs in Greater Manchester and London. The pilot has demonstrated that GPs found that GatewayC helped with future referrals, that there was an improved recognition of symptoms which merited a suspected cancer referral, and increased confidence in knowing when to refer and when not to make a suspected cancer referral.

GatewayC courses are built around true patient stories, using interactive video consultations, specialist interviews and supporting activities. Each course is worth a minimum of two CPD hours and is endorsed by Cancer Research UK. 

For more information or to register, visit the GatewayC website.