Should I see a lung specialist?

It can be very difficult for GPs to decide who may have a cancer and who may have something much more minor that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment such as antibiotics. If GP's referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

There are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Clinical Excellence (NICE) have guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. The guidelines on referrals for lung cancer were revised in 2005. They say that with certain symptoms you should be sent for an urgent chest X-ray and if that shows anything abnormal, then you need to see a specialist. Some symptoms need a referral to a chest specialist and you should see the specialist within two weeks of going to the GP. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) have produced very similar guidelines.

If you cough up blood or have blood in your phlegm (sputum) you should have an urgent chest X-ray.

You should also have an urgent chest X-ray if you have any of the following symptoms for more than 3 weeks with no apparent cause.

• A cough (with or without any of these other symptoms)
• Pain in the shoulder or chest
• Difficulty breathing
• Marked loss of weight
• A hoarse voice
• Enlarged lymph nodes in your neck or above your collarbone
• A particular type of thickening and broadening of the fingertips, called clubbing
• Unexplained changes to symptoms from an existing chronic breathing problem or lung disease
• Other signs that may make your GP suspect you have a cancer that has spread

According to the NICE guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. You should ideally see a specialist urgently if you have

• A chest X-ray that has signs suspicious of lung cancer, with or without other unexplained symptoms
• Coughing up blood that does not get better and you are an ex smoker or a smoker over 40
• A history of asbestos exposure, with recent onset of chest pain and shortness of breath

Your GP should refer you to a specialist straight away if you have either of these symptoms

• Swelling of your face and neck and higher than normal pressure in your jugular vein
• A particular type of very noisy breathing, called stridor

Swelling of the face and neck with raised pressure in the jugular vein is called superior vena cava obstruction (SVCO). The swelling happens when the normal blood flow is partly blocked because the veins in the area are being squashed. The blockage can sometimes be caused by a tumour. Due to the pressure from the blockage fluid leaks out of the vein and causes swelling in the face and neck.

Most lung cancers are diagnosed in people over 60. Only 1 in every 100 is in someone less than 40. Your GP may be more likely to ask you to have a chest X-ray or see a specialist if you

• Smoke, or have done in the past
• Have a smoking related lung disease, such as chronic obstructive pulmonary disease (COPD)
• Have been exposed to asbestos
• Have had another cancer in the past, especially of the head and neck

Your doctor may refer you to a specialist even if you have had symptoms for less than 3 weeks.

If you are worried that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you. Then you may be able to decide together whether you need to see a specialist and if so, how soon.