Guidelines for seeing a kidney cancer specialist

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much less serious that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment such as antibiotics. If GPs referred everyone they saw to a specialist immediately, the system would get jammed and those needing urgent appointments wouldn't be able to get them. But there are particular symptoms that mean your GP should refer you to a specialist straight away.

NICE (the National Institute for Health and Clinical Excellence) have produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. These Government guidelines on referrals for cancer of the kidney were updated in June 2005. While reading these guidelines, it is important to remember that

• Finding blood in your urine is the most common symptom
• Fever, anaemia (low red blood cells), pain across the lower back and weight loss can all be signs of kidney cancer
• Many kidney cancers are found by chance when people are having scans such as CT or ultrasound for other reasons

According to Department of Health guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. The symptoms that NICE say need urgent referral within 2 weeks are

• Blood in your urine, with no symptoms of urine infection (like pain, frequency or urgency of passing urine)
• Blood in the urine with other symptoms, after urine infection has been ruled out by your GP
• Urine infection that won't go away or keeps coming back, and with blood in the urine, in anyone over 40
• Very small amounts of blood in the urine for no apparent reason, and you are over 50
• A lump in your abdomen (either on a scan or felt by your doctor) that your GP thinks could be related to your urinary tract

A urine infection will cause your urine to test positive to small amounts of protein and urine on a 'dipstick' test. Women are more likely to get urine infections than men - simply because the tube to the bladder (the urethra) is much shorter in women, so it is easier for germs to get into the bladder. So your doctor is likely to want to rule out urine infection for women before making an urgent referral, but not necessarily for men.

The guidelines do suggest that you have further urine tests and blood tests if the dipstick finds there are small amounts of blood in your urine. Your doctor may call this 'microscopic haematuria' because you can't see the blood. If you are under 50 and have abnormal results from these tests, your doctor will send you to a kidney specialist. If the results are normal, you are likely to have a non-urgent referral to a urologist.

If you are concerned that your GP is not taking your symptoms as seriously as you think he or she should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.