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'Referral advice' recommendation details

Referral for suspected cancer

Results 11-20 of 53

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG27 In suspected ovarian cancer, any woman with a palpable abdominal or pelvic mass on examination that is not obviously uterine fibroids or not of gastrointestinal or urological origin should have an urgent ultrasound scan. If the scan is suggestive of cancer, or if ultrasound is not available, an urgent referral should be made. Urgent
CG27 In cases of suspected endometrial cancer: - When a woman who is not on hormone replacement therapy presents with postmenopausal bleeding, an urgent referral should be made. - When a woman on hormone replacement therapy presents with persistent or unexplained postmenopausal bleeding after cessation of hormone replacement therapy for 6 weeks, an urgent referral should be made. - When a woman taking tamoxifen presents with postmenopausal bleeding, an urgent referral should be made. - An urgent referral should be considered in a patient with persistent intermenstrual bleeding and a negative pelvic examination. Urgent
CG27 In patients with suspected vulval cancer, an unexplained vulval lump or bleeding should prompt urgent referral. Urgent
CG27 A patient who presents 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
CG27 If a hard, irregular prostate typical of a prostate carcinoma is felt on rectal examination, then the patient should be referred urgently. The prostate-specific antigen (PSA) should be measured and the result should accompany the referral. Patients do not need urgent referral if the prostate is simply enlarged and the prostate-specific antigen (PSA) is in the age-specific reference range. In a male patient with or without lower urinary tract symptoms and in whom the prostate is normal on digital rectal examination (DRE) but the age-specific prostate-specific antigen (PSA) is raised or rising, an urgent referral should be made. In those patients whose clinical state is compromised by other comorbidities, a discussion with the patient or carers and/or a specialist in urological cancer may be more appropriate. Symptomatic patients with high prostate-specific antigen (PSA) levels should be referred urgently. If there is doubt about whether to refer an asymptomatic male with a borderline level of prostate-specific antigen (PSA), the prostate-specific antigen (PSA) test should be repeated after an interval of 1 to 3 months. If the second test indicates that the prostate-specific antigen (PSA) level is rising, the patient should be referred urgently. Urgent
CG27 Referral recommendations in urological cancer: - In suspected bladder and renal cancer, patients of any age who present with painless macroscopic haematuria should be referred urgently. - In male or female patients with symptoms suggestive of a urinary infection who also present with macroscopic haematuria, investigations should be undertaken to diagnose and treat the infection before consideration of referral. If infection is not confirmed the patient should be referred urgently. - In all adult patients aged 40 years and older who present with recurrent or persistent urinary tract infection associated with haematuria, an urgent referral should be made. - In patients under 50 years of age with microscopic haematuria, the urine should be tested for proteinuria and serum creatinine levels measured. Those with proteinurea or raised serum creatinine should be referred to a renal physician. If there is no proteinuria and serum creatinine is normal, a non-urgent referral to a urologist should be made. - In patients aged 50 years and older who are found to have unexplained microscopic haematuria, an urgent referral should be made. - Any patient with an abdominal mass identified clinically or on imaging that is thought to be arising from the urinary tract should be referred urgently. Urgent
CG27 In patients with suspected testicular cancer, any patient with a swelling or mass in the body of the testis should be referred urgently. An urgent ultrasound should be considered in men with a scrotal mass that does not transilluminate and/or when the body of the testis cannot be distinguished. Urgent
CG27 An urgent referral should be made for any patient presenting 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 not involving penile skin are usually not cancer but indicate Peyronie's disease, which does not require urgent referral. Urgent
CG27 In suspected haematological cancer, patients with a blood count or blood film reported as acute leukaemia or persistent unexplained splenomegaly, an immediate referral should be made. Urgent
CG27 Any of the following additional features of lymphadenopathy should trigger further investigation and/or referral: persistence for 6 weeks or more, lymph nodes increasing in size, lymph nodes greater than 2 cm in size, widespread nature, associated splenomegaly, night sweats or weight loss. Urgent

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.