Lung 2WW


This guidance covers the referral of a patient who presents with symptoms of lung cancer who should be referred to a team specialising in the management of lung cancer, depending on local arrangements.

GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.

Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.

Practices with access to ICE

From May 21st 2018, University Hospitals Plymouth (UHP) will be implementing the national optimal lung cancer pathway. To access this new pathway in ICE, please navigate to the 2WW referral tab and select Suspected Lung Cancer.

For practices who do not have access to ICE, the original pathway / 2WW form below are still available.


An urgent referral for a chest x-ray should be made when a patient presents with:

  • haemoptysis, or unexplained or persistent (that is, lasting more than 3 weeks) symptoms and signs:
    • chest and/or shoulder pain
    • dyspnoea
    • weight loss
    • chest signs
    • hoarseness
    • finger clubbing
    • cervical and/or supraclavicular lymphadenopathy
    • cough, with or without any of the above
  • features suggestive of metastasis from a lung cancer (for example, secondary's in the brain, bone, liver or skin)
  • underlying chronic respiratory problems with unexplained changes in existing symptoms

An urgent referral for a chest X-ray or to a team specialising in the management of lung cancer should be made as for other patients but may be considered sooner, for example if symptoms or signs have lasted for less than 3 weeks.


Referral Criteria

Lung cancer or mesothelioma

  • has chest X ray findings that suggest lung cancer or mesothelioma
    • Chest X-ray should be no more than 3 weeks old
  • is aged 40 and over with unexplained haemoptysis
    • Please arrange a chest X-ray to take place in next 48 hours
  • For minor or resolved haemoptysis without other symptoms suggestive of lung cancer, consider just a chest X-ray
  • has a normal chest X-ray but with a high index of suspicion

The following recent blood results, less than 8 weeks old, would be extremely helpful:

FBC, eGFR, clotting, U&E,LFT, bone profile

Referral Instructions

The GP should use e-Referral Service to book an appointment or send the referral.

Please ensure you include:

  • The patient's NHS number
  • Tell the patient that this is an urgent referral and they will be seen within 14 days

e-Referral selection:

  • Specialty: 2WW
  • Clinic type: 2WW Lung
  • Service: DRSS-Western-2WW Lung-NHS Devon CCG

For any patients that you are unable to process through NHS e-Referral please contact the

Referral Forms

Suspected Lung cancer referral form - No merge fields

Suspected Lung cancer referral form - Emis WEB

Suspected Lung cancer referral form - Microtest

Suspected Lung cancer referral form - Systmone with Problems Merge field

Suspected Lung cancer referral form - Systmone with Summary Merge field

Supporting Information


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