Download UROLOGY Suspected Cancer Referral

UROLOGY Suspected Cancer Referral
(2 Week Wait Referral)
To support NICE guidance 2005
Please FAX within 24 hours to Cancer Pathways department: 020 928 8836
Section 1 PATIENT INFORMATION (Please complete in BLOCK CAPITALS)
Date of Referral
Date of Birth
NHS number
UBRN
SURNAME
FIRST NAME
Miss Mrs Ms Mr
Other:_________
/
/
/
/
-
-
Home Tel.
M[ ]F [ ]
Mobile/Daytime Tel.
Address
Transport Y
N
Interpreter Y
N
Language
Ethnicity
Post Code
Section 2 PRACTICE INFORMATION (Please use practice stamp if available)
Referring GP
Locum
Practice Address
Y
N
Telephone
Fax
Post Code
Section 3 CLINICAL INFORMATION (please TICK all applicable entries)
Please enclose print outs of CURRENT medications and PAST MEDICAL HISTORY
Suspected Cancer
Symptoms
Clinical Examination
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[ ] 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:
] Bladder
] Kidney
] Penile
] Prostate
] Renal
] Testicular (confirmed on USS
if this can be arranged without
unreasonable delays)
] 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:
[ ] Other, please specify:
Medical History, Known Allergies
Investigations (Please enclose report)
[ ] Renal mass detected on imaging
PSA:
ng/ml
[ ] Testicular mass detected on imaging
Hb:
[ ] Microscopic haematuria
g/dl
Discussed urgent suspected cancer referral with patient:
Y
N
Medication
Comments/other reasons for suspecting cancer
Hospital use only: (Tick where appropriate)
Date Appointment Booked:
Target Dates
2ww
62/7
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Date of Referral receipt:
Database:

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Patient confirmed:
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A separate letter only need accompany if you feel it necessary
Approved by the North East London Cancer Network April 2006
LOCAL CONTACT DETAILS
If you wish to discuss any clinical issues concerning this referral please contact:
Mr John Hines
Mr James Green
Mr John Peters
John O’Neil
Consultant Urologist
Consultant Urologist
Consultant Urologist
Clinical Nurse Specialist
020 8535 6741
020 8535 6574
020 8535 6725
0208 539 5522-Bleep 147
If you wish to discuss any other aspect of this referral please contact the Cancer Pathways
Office on 020 8535 6856/ 020 8535 6768 x4348 x4350
CRITERIA FOR URGENT SUSPECTED CANCER REFERRAL1
Please FAX the referral form within 24 hours
Refer a patient who presents with symptoms or signs suggestive of a urological
cancer to a team specialising in the management of urological cancer, depending on
local arrangements
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 agespecific 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
ng/ml
2.5*
3.0
4.0
70 + years
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.
1 Based on Referral Guidelines for Suspected Cancer (NICE, 2005)
Notes in grey refer to the evidence grading used in the NICE guidelines, for more information see
www.nice.org.uk/cg027NICEguideline