Survival from lung cancer in England and Wales up to 2001

No screening services are provided for early detection of cancer of the lung in England and Wales as there is currently no evidence that population screening is effective in reducing mortality ( Manser et al, 2003 ). Most patients in the United Kingdom present to their primary care physician. Lung cancer should be suspected in any smoker with new or worsening respiratory symptoms including haemoptysis, or indication of systemic illness such as anorexia, malaise or weight loss ( NICE, 2005 ). If a chest X-ray suggests lung cancer, then patients are offered urgent referral to a member of the lung cancer multidisciplinary team, usually a chest physician. The diagnosis may be confirmed from sputum cytology, bronchoscopy, percutaneous needle biopsy or open biopsy. Staging of lung cancers is by computed tomography (CT). Prompt referral and good teamwork are essential at every stage of management. Many advances in diagnosis and treatment have the potential to improve outcome in lung cancer. These demand a high degree of specialisation and multidisciplinary care. Such recommendations have appeared in guidelines published in the 1990s ( SMAC, 1994 ; BTS, 1998 ; NHSE, 1998 ; SIGN, 1998 ). Positron emission tomography (PET) imaging became clinically available in a limited number of centres in the mid-1990s. It is a useful tool for refining the diagnosis and staging in patients with possible lung cancer. More recent guidelines recommend that patients who are staged as candidates for surgery or radical radiotherapy on CT should have an 18 F-deoxyglucose-PET (FDG-PET) scan to look for involved intrathoracic lymph nodes and distant metastases ( NICE, 2005 ). However, solitary extrapulmonary focal FDG accumulation may be due to a benign tumour or to inflammation. ( Lardinois et al, 2005 ).