Authors: Hawary, Amr M.; Warburton, Hazel E.; Brough, Richard J.; Collins, Gerald N.; Brown, Stephen C.; O'Reilly, Patrick H.; Adeyoju, Adebanji A.B.

Source: Annals of The Royal College of Surgeons of England, Volume 90, Number 6, September 2008 , pp. 517-522(6)

Publisher: The Royal College of Surgeons of England

Abstract:

INTRODUCTION: All NHS-suspected cancers should be seen within 2 weeks of referral and are referred under government guidelines (Health Service Circular 205; HSC 205). This policy will be subject to review in 2009. Review is vital to allow the appropriate detection of malignancy without overburdening the premium clinic slots with the healthy.

PATIENTS AND METHODS: A total of 170 consecutive patients were referred from January-June 2005. Referral details, patient information, events and time to diagnosis were recorded.

RESULTS: Of these 170 patients, 143 were suitable for analysis. Forty-three patients (30%) were referred with frank haematuria, of whom 30% had bladder cancer. Nine percent of patients (n = 13) had microscopic haematuria none of whom had cancer. A quarter of the patients (n = 35) were referred with suspected testis cancer but none had cancer. Forty-one patients were referred with serum prostate-specific antigen (PSA) elevation; 18 cancers were detected in this group. Ten men had PSA values greater than 50 ng/ml. Only two cancers were suitable for radical prostatectomy. No cancer was found in patients less than 50 years of age.

CONCLUSIONS: A high cancer incidence was found (27.9%), the majority of which was bladder cancer or advanced prostate cancer. Out of the 143 patients, no malignancy was diagnosed in any patient less than 50 years of age, no malignancy was diagnosed in any of the microscopic haematuria group and there was no cancer diagnosed in the group of patients referred with scrotal swellings. We suggest that some guidelines are leading to referral of patients with low cancer risk. When the HSC 205 is revised in 2009, we hope studies such as ours are taken into consideration in order to improve resource utilisation.

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Keywords: '2-WEEK WAIT' RULE; CANCER TARGETS; PSA; MACROSCOPIC HAEMATURIA; TESTICULAR MASS; CANCER INCIDENCE

Document Type: Research article

DOI: http://dx.doi.org/10.1308/003588408X301082

Affiliations: 1: Department of Urology, Stepping Hill Hospital, Stockport, UK

Publication date: 2008-09-01

More about this publication?

• The Annals of The Royal College of Surgeons of England is the official journal of the College and is published eight times a year in January, March, April, May, July, September, October and November. The main aim of the journal is to publish high quality, peer-reviewed papers that relate to all branches of surgery.
  
  The Annals also includes letters and comments, a regular technical section, NICE news, controversial topics, CORESS feedback, book reviews and the best trainee presentations from England and Wales. The editorial board is composed of members of the College Council and experts from across the surgical specialties.
  
  Archive issues of the Annals of The Royal College of Surgeons of England are available via the PubMed Central database
  
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