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Lung - USC (2WW)

Checked: 03-06-2024 by Rob Adams Next Review: 02-06-2025

Service Overview

Services provided by UHBristol at the Bristol Royal Infirmary and NBT at Southmead Hospital. The services are for patients who meet the Lung Cancer Urgent Suspected Cancer (USC) criteria. The service offers consultation with diagnostics and onward referral for treatment as required.

Contact details ADULT USC (2WW):

NBT - Tel on 0117 414 0522 / 0536 / 0537 / 0538 or email to fasttrackoffice2ww@nbt.nhs.uk

UHBW - Tel on 0117 342 7641 / 2 / 3 / 4 or email to FastTrackOffice@uhbw.nhs.uk

Local Pathway

Refer to the local pathway for Suspected Lung Cancer (PDF).

Patients referred for CXR

All patients who are referred for CXR should be encouraged to attend within 72hours. CXR requests should include all relevant clinical details - particularly if they raise suspicion of malignancy. Patients should also be made aware that they may be contacted by secondary care for further tests if their CXR findings are unclear. This is also supported by the relevant patient information leaflets for instructions on how to get direct access to radiology:

UHBW - Place the request on ICE. Please ask patients to attend the chosen site. Open Access will be available from 03/06/24 for Chest X-Ray at UHBW (cross site - BRI, SBCH, WGH), 09:00-17:00, Monday to Friday. SBCH will still be offering appointments outside of those core hours (evenings and weekends), with the same conditions of urgency and mobility as before.
NBT - please ask the patient to attend Southmead Hospital, Gate 18, Imaging department between 9am – 4pm, Mon-Fri, (closed Bank Holidays). The clinical history must include the term: Lung USC/2WW. Should the patient request Imaging at Cossham, Clevedon or Yate West Gate Centre they will need to call 0117 4145175. Lines are open Mon-Fri 8.45am to 4.15pm. (Closed bank holidays) and an appointment will be offered within 72 hours of calling the booking line.

All GP requested CXRs should be reported within 24hours.

If the CXR is suspicious for lung cancer then this will result in the patient being booked for CT (reflex CT) which will be arranged by secondary care. GPs must also submit a USC referral (see section below) with any relevant details at this point. For further details please see the following document:

Direct referral to CT following abnormal CXR - this is now active at NBT, UHB and Weston.

Patients with normal CXR but who still have red flag symptoms or signs

Up to 25% of chest X-rays can be falsely negative in lung cancer, so if the clinical suspicion is high, or there is clinical lymphadenopathy or finger clubbing, refer urgently to the fast track lung cancer service using the USC referral form (see Referral section below).

If advised to refer into MDT, then please submit a USC referral to the relevant secondary care team who will ensure that all the required information is available to enable an effective MDT discussion.

The following NICE guidelines may also be helpful:

CKS Guidelines on the recognition and referral of Lung Cancer.

Referral

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

All patients referred on this form MUST have had a chest x-ray and/or CT chest within the last 4 weeks. If no chest x-ray has been performed at time of referral please request urgently to be performed before referral.

Patients should be referred using the Suspected Lung Cancer Referral Form (word doc).

USC Lung Cancer referrals cannot be made to Weston General Hospital

Referrals to NBT - Refer via: Urgent Suspected Cancer - Lung Malignancies Triage Service - Southmead - RVJ. Select 'send for triage' in eRS rather than selecting a date and time for dummy appointment.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.