Intended for healthcare professionals

Practice Guidelines

Diagnosis and treatment of lung cancer: summary of updated NICE guidance

BMJ 2011; 342 doi: (Published 27 April 2011) Cite this as: BMJ 2011;342:d2110
  1. D R Baldwin, consultant respiratory physician1,
  2. B White, consultant neurosurgeon1,
  3. M Schmidt-Hansen, researcher2,
  4. A R Champion, centre manager2,
  5. A M Melder, senior researcher3
  6. on behalf of the Guideline Development Group
  1. 1Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
  2. 2National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK
  3. 3Centre for Clinical Effectiveness, Southern Health, Clayton, Victoria 3168, Australia
  1. Correspondence to: Dr D R Baldwin, Consultant Respiratory Physician, Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, City Campus, Hucknall Road, Nottingham, NG5 1PB david.baldwin{at}

Each year in the United Kingdom over 35 000 people die from lung cancer, 4000 more than from breast and bowel cancer combined,1 and survival remains lower than in other developed countries.2 Inequality exists in the UK in the delivery of treatment with curative intent3 as well as in delivery of active treatments generally. All healthcare professionals involved at any stage of the care pathway have important roles to play in tackling these inequalities. Thus the 2005 guidance from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and treatment of lung cancer was updated to advise healthcare professionals of important advances in management and to ensure patients have a supported, informed choice of the treatment that will help them most. This article summarises the recommendations from the updated NICE guideline on the diagnosis and treatment of lung cancer.4


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Early diagnosis and referral

  • Ensure that patients have the best chance of early diagnosis by prompt attention to warning symptoms and promotion of public awareness of these (box).

Referral (recommendations retained from 2005)

  • Offer urgent referral for a chest radiography when a patient presents with:

    • -Haemoptysis or

    • -Any of the following unexplained or persistent (lasting more than three weeks) symptoms or signs: cough, chest or shoulder pain, dyspnoea, hoarseness, weight loss, chest signs, finger clubbing, features suggestive of metastasis from a lung cancer (for example, in the brain, bone, liver, or skin), or cervical or supraclavicular lymphadenopathy

  • If chest radiography or chest computed tomography suggests lung cancer (including pleural effusion and slowly resolving consolidation), …

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