Intended for healthcare professionals

Practice Guidelines

Lung cancer: diagnosis and management: summary of updated NICE guidance

BMJ 2019; 364 doi: (Published 28 March 2019) Cite this as: BMJ 2019;364:l1049
  1. Ross Maconachie, technical adviser in health economics1,
  2. Toby Mercer, technical analyst1,
  3. Neal Navani, consultant in thoracic medicine2,
  4. Gary McVeigh, professor of cardiovascular medicine and consultant physician, chair of the guideline committee3
  5. on behalf of the Guideline Committee
    1. 1National Institute for Health and Care Excellence, London, UK
    2. 2Lungs for Living Research Centre, UCL Respiratory, University College London; and Department of Thoracic Medicine, University College London Hospital, London, UK
    3. 3Queen's University Belfast; and Belfast Health and Social Care Trust, Belfast, UK
    1. Correspondence to: R Maconachie ross.maconachie{at}

    What you need to know

    • The NICE guideline for lung cancer focuses on diagnosis and treatment, it does not cover referral for suspected cancer

    • The guidance has been updated, and the new recommendations are largely relevant to secondary care settings, but some updates may be useful for non-specialists to be aware of

    • A new staging algorithm for non-small cell lung cancer describes when to use several diagnostic and staging investigations and in what order

    • A new systemic therapy algorithm recommends medications for advanced non-small cell lung cancer based on patient tumour histology and biomarkers and will be periodically updated as new developments occur

    • People with stage II and III non-small cell lung cancer being considered for curative treatment should receive brain imaging prior to treatment as the presence of brain metastases alters their management plan.

    What this guideline update covers

    This National Institute for Health and Care Excellence (NICE) guideline update covers the diagnosis and treatment of lung cancer.1 Recommendations on referral for suspected cancer are covered in a separate guideline.2

    Why did it need updating?

    New trials and systematic reviews have been published in several relevant areas since the 2011 update of this guideline, particularly in the areas of staging, radiotherapy, and systemic treatments.

    Who is it for?

    The new recommendations are largely focused on secondary care, but the guideline is relevant to all stakeholders with an interest in the diagnosis and management of patients with lung cancer, including those in primary care.

    What evidence was reviewed?

    Evidence was reviewed on the use of:

    • Non-ultrasound-guided transbronchial …

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