Bladder and kidney cancer

Scottish referral guidelines for suspected cancer
Centre for Sustainable Delivery

Urgent suspicion of cancer (USC) referral

Refer a person with any of the following to the Urology Service as a USC:

  • Unexplained Visible Haematuria:

Aged under 45 years:

    • more than 1 episode without UTI (not limited to a time duration)
    • recurs/persists after treatment of UTI

Aged 45 years and over:

    • single episode without UTI
    • recurs/persists after treatment of UTI
  • Unexplained Non-Visible Haematuria

Aged 60 years and over:

    • persistent blood on repeat urine dipstick (between 2 to 6 weeks apart) and has a negative urine culture
  • Abdominal mass identified on imaging that is thought to arise from the urinary tract

 

Assessment for suspected bladder and kidney cancer

The presenting features of bladder and kidney cancer include:

  • Visible haematuria – the most common
  • Loin pain
  • Renal masses
  • Persistent non-visible haematuria
  • Anaemia
  • Weight loss
  • Pyrexia

Good practice points

A urine culture should be obtained if a person presents with haematuria (visible or non-visible).

Consider seeking urology advice if there are recurrent issues with haematuria in patients who have had recent (within six months) negative investigations for haematuria. This does not need to be a USC referral.

There is an online risk calculator for bladder cancer available.  

A single episode of visible haematuria in those aged under 45, in the absence of a UTI, does not meet the criteria for a USC referral. Consideration should be given to imaging or referral to urology through an alternative pathway, based on local guidelines.

Evidence suggests that certain groups may be at an increased risk of diagnostic delays and missed diagnostic opportunities - this includes older women with UTIs79, those with recurrent UTIs80, and people presenting with non-haematuria symptoms81.

 

Overlap with other pathways:

Patients with intra-abdominal cancer can present with symptoms that overlap. Please see Upper and Lower GI cancer guidelines and Ovarian cancer guideline. Data shows a PPV of 5% for kidney cancer in men aged 60 or over with abdominal pain and microcytosis (low mean corpuscular volume without the additional need for anaemia)16.

Patients with abdominal pain would normally be assessed and referred using the Upper or Lower GI cancer guidelines. A USS of the abdomen including the kidneys, or a USC referral to urology, should be considered if no cause is found and the kidneys have not been imaged.

 

Background

There are around 860 new bladder and 1,150 new kidney cancers in Scotland each year (bladder figures cover ICD-10 code C67 (Malignant neoplasm of bladder). PHS will be adding ICD-10 codes D09.0 and D41.4 to future data files. 98% of kidney cancer cases are aged 40 years or over and 99% of bladder cancer cases are aged 45 years or over at the time of diagnosis1. Risk factors include:

  • Male sex (crude rates of kidney cancer are 2 times higher and bladder 2.3 times higher in males1)
  • Smoking history
  • Family history