A cough that is not going away, shortness of breath, coughing up blood, chest or shoulder pain, repeated chest infections or one that will not clear, losing weight without trying, loss of appetite, feeling tired all the time (NHS)
Less common : swelling of the face or neck, difficulty swallowing, a hoarse voice that does not go away, finger clubbing (NHS)
A tumour at the top of the lung can press on the nerves and vessels there and cause shoulder and arm pain with a drooping eyelid rather than any chest symptom at all (a Pancoast or superior sulcus tumour)
Early disease often causes nothing, which is why a third of English cases still reach the hospital as an emergency (Cancer Research UK)
GP referral rules (NICE NG12 1.1.1 to 1.1.3): suspected cancer pathway referral for chest X-ray findings suggesting lung cancer or unexplained haemoptysis at 40 and over; urgent direct access chest X-ray at 40 and over for two or more of cough, fatigue, shortness of breath, chest pain, weight loss and appetite loss, or one of them in anyone who hasever smoked; consider one for persistent or recurrent chest infection, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs, or thrombocytosis
See a GP for a cough lasting more than 3 weeks; ask for an urgent appointment or call NHS 111 if you cough up blood; call 999 if you are struggling to breathe or have pain in the chest or upper back (NHS)
Brain imaging by stage : none for clinical stage 1 without neurological symptoms (brain metastasisprevalence about 4 percent), contrast-enhanced CT for stage 2, contrast-enhanced MRI for stage 3 (NICE NG122 1.2.24 to 1.2.26)
The sample must be adequate for subtyping and molecular markers; the panel is set by the National Genomics Test Directory, not by the guideline (NICE NG122 1.2.11, 1.2.12)