Download Urological Suspected Cancer Referral

Urological Suspected Cancer Referral
(2 Week Wait Referral)
Please FAX within 24 hours to Cancer Two Week Wait Office on eFax number 020 3594 3278
LOCAL CONTACT DETAILS
Cancer Two Week Wait Office, Barts and The London NHS Trust
Tel 0207 767 3333 , eFax number 020 3594 3278
For queries on appropriateness of referral contact
Urology Clinical Nurse Specialist/MDT Coordinator on 02034657391 or 02034656412
Section 1 PATIENT INFORMATION (Please complete in BLOCK CAPITALS)
Date of Referral
SURNAME
Date of Birth
NHS number
FIRST NAME
UBRN
Miss Mrs Ms Mr Other:_________
M[ ]F [ ]
Language
Address:
/
/
-
-
Home Tel.
Mobile/Daytime Tel.
Next of Kin Tel.
Transport Y
Post Code:
/
/
N
Interpreter Y
N
Performance Status
Section 2 PRACTICE INFORMATION (Please use practice stamp if available)
Locum
Referring GP
Practice Address
Telephone
Post Code
Fax
Section 3 CLINICAL INFORMATION (please TICK all applicable entries)
Please enclose print outs of CURRENT medications and PAST MEDICAL HISTORY
Suspected Cancer
Symptoms
[
[
[
[
[
[
] Bladder
] Kidney
] Penile
] Prostate
] Renal
] Testicular (confirmed on USS
if this can be arranged without
unreasonable delays)
[ ] Other, please specify:
Investigations (Please enclose report)
[
[
[
[
[
[
[
[
] Bone pain
] Loin pain
] Macroscopic haematuria of any age
] Microscopic haematuria if age > 40 yrs
] Persistent or recurrent UTI
] Testicular swelling
] Raised PSA
] Other, please specify:
ng/ml
[ ] Renal mass detected on imaging
[ ] Testicular mass detected on imaging
[ ] Microscopic haematuria
Other Notes:
PSA:
Hb:
g/dl
Y
N
Clinical Examination
[ ] Penile skin lesion
[ ] Prostate feels malignant
on rectal examination
[ ] Pyrexia
[ ] Renal mass
[ ] Swelling and/or inguinal
lymph nodes in body of testis
[ ] Other, please specify:
Medical History and Known Allergies
Medication
Discussed urgent suspected cancer referral with patient:
Yes / No
Patient available for an appointment within 2 weeks:
Yes / No
Comments/other reasons for suspecting cancer
Hospital use only: (Tick where appropriate)
Date Appointment Booked:
Target Dates
2ww
62 day
/
/
/
/
/
Date of Referral receipt:
/
Database: 
/
Patient confirmed:
/

CRITERIA FOR URGENT SUSPECTED CANCER REFERRAL
Refer urgently patients:
Prostate
 with a hard, irregular prostate. Prostate-specific antigen (PSA) should be measured and the result should
accompany the referral. (An urgent referral is not needed if the prostate is simply enlarged and the PSA
is in the age-specific references range)
 with a normal prostate, but rising/raised age-specific PSA, with or without lower urinary tract symptoms.
(In patients compromised by other comorbidities, a discussion with the patient or carers and/or a
specialist may be more appropriate.) C
 with high PSA levels
Bladder and renal
 of any age with painless macroscopic haematuria
 aged 40 years and older who present with recurrent or persistent urinary tract infection associated with
haematuria
 aged 40* years and older who are found to have unexplained microscopic haematuria
 with an abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract
Testicular
 with a swelling or mass in the body of the testis
 with high tumour markers: AFP, BHCG, LDH.
Penile

with symptoms or signs of penile cancer. These include progressive ulceration or a mass in the glans or
prepuce particularly, but can involve the skin of the penile shaft. (Lumps within the corpora cavernosa
can indicate Peyronie’s disease, which does not require urgent referral.)
* Age threshold in NELCN, NICE guidance suggests 50 years
Age related PSA upper levels
Age
40 – 49 years
50 - 59 years
60 - 69 years
70 + years
ng/ml
2.5*
3.0
4.0
5.0
Recommended by the Prostate Cancer Risk Management Programme except * indicating NELCN agreed.
Please do not use the proforma for non urgent referrals
Refer the patient by means of a routine referral letter
Investigations

In an asymptomatic male with a borderline level of PSA, repeat the PSA test after 1 to 3 months. If the
PSA level is rising, refer the patient urgently

A digital rectal examination and a PSA test (after counselling) are recommended for patients with any of
the following unexplained symptoms:
 inflammatory or obstructive lower urinary tract symptoms
 erectile dysfunction
 haematuria
 lower back pain
 bone pain
 weight loss, especially in the elderly

Exclude urinary infection before PSA testing. Postpone the PSA test for at least 1 month after treatment
of a proven urinary infection

In male or female patients with symptoms suggestive of a urinary infection and macroscopic haematuria,
diagnose and treat the infection before considering referral. If infection is not confirmed, refer them
urgently
Prostate Cancer
99% of cases occur in men aged 50+ years. Over 25% of cases present in men less than 70 years when life
expectancy is long. Presenting features include raised prostate specific antigen (PSA), an abnormal rectal
examination, bone pain and (occasionally) spinal cord compression.
Lower urinary tract symptoms are common in the normal population. Lower urinary tract symptoms alone are
not a reason for suspecting prostate cancer. Early curable prostate cancer will rarely be the cause of lower
urinary tract symptoms. Early prostatic cancers are either impalpable or have only a small nodule.
Bladder/Urothelial Cancers
95% affect the bladder; 5% affect the upper tracts. 90% of patients present with macroscopic haematuria.
Macroscopic haematuria, when caused by a urothelial cancer, may be intermittent. Repeat urine testing can be
negative for haematuria in the presence of a tumour.
Kidney
Macroscopic Haematuria is the commonest presenting symptom
Other presenting features: loin pain, renal mass, microscopic haematuria, anaemia, weight loss, pyrexia,
although the common presentation is an incidental finding on abdominal imaging (e.g. CT or ultrasound).
Testis
Scrotal swellings are relatively common in general practice
Solid swellings affecting the body of the testis have a high probability (50+%) of
being due to cancer, especially in men aged 15 – 55.
Indeterminate swellings of the testicle have a low probability of being due to cancer, especially in men over 55
years, and swellings outside the body of the testis are rarely malignant, and do not need referring urgently.