Tag: kidney
Urology, Suspicion of Cancer Referral
Urological cancers
Prostate cancer
Prostate cancer is the most common cancer in males in Scotland, with approximately 2,800 new cases diagnosed every year. Risk increases with age and approximately 99% of cases are diagnosed in men aged over 50 years. Men are 2.5 times more likely to be diagnosed with prostate cancer, if their father or brother has had it. In the UK, the lifetime risk of prostate cancer in Black men (1 in 4) is double that of the lifetime risk of all men combined (1 in 8).
Men presenting with unexplained possible symptoms and signs suggestive of prostate cancer such as changes to urinary patterns, erectile dysfunction, haematuria, lower back pain, bone pain or weight loss should have a digital rectal examination and a prostate specific antigen (PSA) test with counselling. A PSA test should not be performed within 1 month of a proven urinary tract infection (UTI). It should be noted that the majority of men with prostate cancer have no symptoms at all.
Bladder and kidney cancer
Visible haematuria is the most common presenting symptom for both bladder and kidney cancer. Other presenting features include loin pain, renal masses, non-visible haematuria, anaemia, weight loss and pyrexia. Both cancers are uncommon, with around 800 new bladder and 860 new kidney cancers each year.
Testicular and penile cancer
Although scrotal swellings are a common presentation in general practice, testicular cancer is relatively rare, with around 200 new cases per annum, of which approximately 70% are between 15 and 45 years. Solid swellings affecting the body of the testis have a high probability (>50%) of being due to cancer. Cancer of the penis is rare, with around 60 new cases each year in Scotland, but its incidence is rising.
All patients presenting with symptoms or signs suggestive of urological cancer should be referred to a team specialising in the management of urological cancer, depending on local arrangements.
Urgent suspicion of cancer referral
Prostate cancer
Evidence from digital rectal examination of a hard, irregular prostate
Elevated or rising age-specific PSA. Rough guide to normal PSA levels:
- men less than 60 years – less than 3ng/ml
- men aged 60 – 69 years – less than 4ng/ml
- men aged 70 years and over – less than 5ng/ml
Bladder and kidney cancer
- Patients with painless visible haematuria
- Patients with non-visible haematuria and symptoms suggestive of UTI but with sterile mid-stream urine (MSU)
- Abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract
Testicular and penile cancer
- Swelling in the body of the testis
- Suspicious scrotal mass found on imaging
- Men considered to have epididymo-orchitis or orchitis which is not responding to treatment
- Any non-healing lesion on the penis or painful phimosis
Non urgent referral
- Elevated age-specific PSA where urgent referral will not affect outcome due to age or comorbidity
- Asymptomatic persistent non-visible haematuria without obvious cause
- Patients over 40 who present with recurrent UTI associated with any haematuria
Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 85 – Management of transitional cell carcinoma of the bladder
Clinical Lead: Mr Rehan Khan, Consultant Urology Surgeon, NHS Lanarkshire
Review Date April 2017
Renal Referral Guidelines
| Renal Medicine | Consultant | Direct Line to Secretaries |
|---|---|---|
| Monklands Hospital | Dr W. G. J. Smith | 01236 712640 |
| Monkscourt Avenue | Dr M. F. Hand | 01236 712641 |
| Airdrie | Dr I. R. Shilliday | 01236 712582 |
| ML6 0JS | Dr J. P. Traynor | 01236 713167 |
| Switchboard | 01236 748748 | |
| Fax Number | 01236 712179 |
Background
The renal unit is mostly centred at Monklands although we have some clinics at Wishaw and Hairmyres. It is likely that your patient will be reviewed at Monklands first. Background info on the renal unit is available via the FirstPort website. This also includes access to our guidelines including CKD guidelines and advice on the use of ACE inhibitors and ARBs. These are held in the Renal Documents Library on FirstPort
Referral Process
We have two categories of referral – routine and urgent. A routine patient will be seen in approximately 9 weeks. An urgent referral should be made if you think the patient may need to be admitted and we would prefer the urgent referral is coupled with a phone call at the time of referral to discuss the case.
Reasons for Referral
For outpatient review (or at least discussion) include:
- Stage 4 and 5 CKD (i.e. eGFR < 30 ml/min on two measurements three months apart)
- Significant proteinuria i.e. ACR > 70 (or > 30 if under 55 years)
- Difficult to control hypertension
- Stage 3 CKD if under 55 years old or > 10ml/min loss of renal function over a 12 month period
To make the first visit much more meaningful it would therefore be extremely useful if the following investigations could be ordered at the time of referral (unless already available):
Essential
- Renal ultrasound – (Please refer all patients unless they have had a recent scan via Clinical Radiology to HH, MDGH and WGH on SCI Gateway. Choose the option Renal Scan- referred to renal clinic)
This will then trigger an USS which will include Renal size, renal cortex, aorta and presence or absence of hydronephrosis. If hydronephrosis is found, then a bladder USS will be undertaken.
If a renal mass is found, radiology will automatically self refer for CT and access the lab browsers for the eGFR (blood for this should have been taken as part of the renal referral process). Information regarding diabetes and metformin use should be included in the referral
The initial report will be sent to primary care as if there is a mass or obstruction this should be referred through to Urology. Renal team will have direct access to the reports in clinic so do not need the reports forwarded. With a clinic waiting time of 6-8 weeks, the USS will always be done before the patient is seen in clinic
Bloods
- Renal Profile( Request RENP), CRP, FBC. ( RENP=UE (including Bic), bili, ALT, AST, ALP, GGT, Ca, Alb, PO4)
Urine
- Urine for Albumin/Creatinine Ratio (the labs accept the abbreviation ˜ACR)
Non Essential
- All ages ‘vasculitic screen’
- Rheumatoid factor (RF), anti-nuclear antibodies (ANA), ANCA and C3 C4
If over 40 years old
- Serum electropheresis and immunoglobulins (can be requested SEP and IgGs on the request form) and urine for Bence Jones protein (BJP)
On the main referral page several items are coded as mandatory fields. We hope you will be willing to put up with the minor frustration this might cause you to ensure that our mutual patient’s journey through the clinic system is made as meaningful and quick as possible.