How do I determine the appropriate referral pathway for a patient with a renal mass identified on imaging?

To determine the appropriate referral pathway for a patient with a renal mass identified on imaging, consider the following:

• Age and symptoms: If the patient is aged 45 years or over and has unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after treatment, refer using a suspected cancer pathway referral for renal cancer, which means an appointment within 2 weeks.
• Referral urgency: This referral is urgent (within 2 weeks) as per the NICE guideline on suspected cancer recognition and referral.
• Specialist discussion: If there is uncertainty about the interpretation of the renal mass or symptoms, consider discussing with a specialist (e.g., by telephone or email) to clarify the need and urgency of referral.
• Include all relevant information: Ensure referral letters include all pertinent clinical details and specify the urgency of the referral.

In summary, a renal mass on imaging in a patient aged 45 or older with relevant haematuria should prompt an urgent suspected cancer pathway referral to urology for further assessment.

This approach aligns with the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral and the Clinical Knowledge Summaries (CKS) on urological cancers.