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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 [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ ] 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 / / / / / / Date of Referral receipt: Database: / Patient confirmed: / 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