Quality statement 1: Suspected cancer pathway referral
Quality statement
Adults aged 45 and over with visible haematuria, that is not caused by a urinary tract infection or that persists after successful treatment of a urinary tract infection, are referred for assessment using a suspected cancer pathway.
Rationale
Visible haematuria (blood in the urine) in adults aged 45 and over that is not caused by a urinary tract infection or that persists after successful treatment of a urinary tract infection is a possible symptom of renal or bladder cancer. Referral using a suspected cancer pathway will support a faster diagnosis and earlier access to treatment.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of adults aged 45 and over with visible haematuria, that is not caused by a urinary tract infection or that persists after successful treatment of a urinary tract infection, who are referred for assessment using a suspected cancer pathway.
Numerator – the number in the denominator who are referred for assessment using a suspected cancer pathway.
Denominator – the number of adults aged 45 and over with visible haematuria that is not caused by a urinary tract infection or that persists after successful treatment of a urinary tract infection.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
b) Proportion of adults aged 45 and over with confirmed renal cell carcinoma (RCC) who were referred for assessment using a suspected cancer pathway.
Numerator – the number in the denominator who were referred for assessment using a suspected cancer pathway.
Denominator – the number of adults aged 45 and over with confirmed RCC.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The National Disease Registration Service's Routes to Diagnosis tool (download: time trend data for all cancer sites by age group) presents data on suspected cancer referrals for kidney cancer for adults aged 50 and over.
Outcome
Proportion of adults aged 45 and over with confirmed RCC who were diagnosed after an emergency presentation.
Numerator – the number in the denominator who were diagnosed after an emergency presentation.
Denominator – the number of adults aged 45 and over with confirmed RCC.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The National Disease Registration Service's Routes to Diagnosis tool (download: time trend data for all cancer sites by age group) presents data on emergency presentations for kidney cancer for adults aged 50 and over.
What the quality statement means for different audiences
Service providers (such as GP practices, community hubs and secondary care services) ensure that systems and processes are in place for adults aged 45 and over with visible haematuria, that is not caused by a urinary tract infection or persists after successful treatment of a urinary tract infection, to be referred for assessment using a suspected cancer pathway.
Healthcare professionals (such as GPs) refer adults aged 45 and over with visible haematuria, that is not caused by a urinary tract infection or persists after successful treatment of a urinary tract infection, for assessment using a suspected cancer pathway.
Commissioners ensure that suspected cancer pathways are in place for adults aged 45 and over with visible haematuria that is not caused by a urinary tract infection or persists after successful treatment of a urinary tract infection.
Adults aged 45 and over with visible blood in their urine, who do not have a urinary tract infection or have been successfully treated for a urinary tract infection, are referred for an urgent assessment to check for cancer.
Source guidance
Suspected cancer: recognition and referral. NICE guideline NG12 (2015, updated 2026), recommendation 1.6.6
Definitions of terms used in this quality statement
Assessment
Assessment should include:
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a urea and electrolyte profile blood test to assess renal function (creatinine and estimated glomerular filtration rate [eGFR]), if not done at referral
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a renal and bladder ultrasound, CT urography (CTU), or both
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if upper tract urothelial tumours are suspected, excretory-phase imaging has not already been done and eGFR allows, then CTU should be done
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abdominal imaging, if there is not enough information from any previous imaging to inform next steps. The imaging should consist of either or both:
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multiphasic contrast-enhanced CT (CECT)
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MRI (ideally with contrast), if the adult cannot have multiphasic CECT or if more information is needed after multiphasic CECT
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CT of the chest and pelvis (ideally with contrast), if possible RCC is detected on abdominal imaging, to complete staging.
[NICE's guideline on kidney cancer, recommendations 1.2.1 to 1.2.3, and NHS England's implementing timed urology cancer diagnostic pathway – bladder, penile, renal and testicular]
Suspected cancer pathway
Adults aged 45 and over with visible haematuria, that is not caused by a urinary tract infection or that persists after successful treatment of a urinary tract infection, receive a diagnosis or ruling out of cancer within 28 days of being referred urgently by their GP. For further details, see NHS England's webpage on operational management, administration and performance – faster diagnosis standard. [NICE's guideline on suspected cancer, terms used in this guideline]
Equality and diversity considerations
Data from Cancer Research UK show that more males than females in the UK develop and die from kidney cancer. The committee highlighted that healthcare professionals should be aware that recurrent urinary tract infection in women, trans men and non-binary adults with a female urinary system who are experiencing menopause may be misdiagnosed. Their urinary tract infections may be incorrectly attributed to menopause rather than recognised a symptom of kidney cancer. This group should be carefully assessed, to help reduce the risk of delayed referral.