Urological tumour or cancer: Individual from a family in whom a mutation in a cancer predisposition gene has NOT been identified

ADULT PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • No referrals to emergency relating to clinical genetics
    • The offer of an appointment by GHQ does NOT guarantee that the patient will be offered a publicly funded gene test.
    • If the patient is an UNTESTED blood relative of a person with an identified mutation in a cancer predisposition gene, please refer to the Untested blood relative condition within the Genetics CPC
    • If the patient has undergone mainstreamed and/or private genetic testing refer to the Mainstreamed or private testing condition within the Genetics CPC
    • Eligibility for publicly funded genetic testing will be determined using eviQ criteria. See eviQ prostate cancer panel testing protocol for current guidelines for genetic testing for prostate cancer (link).
    • If SDH-deficient or HLRCC associated kidney cancer is suspected please arrange for IHC for SDHA, SDHB and fumarate hydratase to be undertaken prior to or at the time of referral (further information can be found on the GHQ website).
    • If the patient fulfils eviQ criteria for genetic testing and has a very limited life expectancy, arrange for two separate blood collections of 2x4mL EDTA tubes each to be sent to the Molecular Genetics Laboratory, Pathology Queensland (RBWH) for “DNA extraction and storage” prior to or at the time of referral. Advise Pathology Queensland that these specimens have been collected in accordance with Genetics Health Queensland protocols.
    • Patients will be mailed a family history questionnaire to complete and return. Failure to do so may result in removal of the patient from the waitlist.
    • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC

    Clinican resources

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Patients that fulfil Category 2 or 3 criteria for renal cell or urothelial cancer, and their cancer is metastatic
  • Hereditary leiomyomatosis and renal cell cancer (HLRCC)- associated renal cell carcinoma, papillary type 2 renal cell carcinoma, fumarate hydratase (FH)-deficient renal carcinoma
  • Anaplastic sarcoma of the kidney
  • Metastatic castrate resistant prostate cancer
Category 2
(appointment within 90 calendar days)
  • Urothelial (transitional cell) carcinoma that is MMR-deficient
  • Personal history of urothelial carcinoma and at least one of the following:
    • a family history of at least one close relative with colorectal or endometrial cancer diagnosed at age < 50 years
    • at least two close relatives with a Lynch syndrome-associated cancer at any age (further information can be found on the GHQ website)
  • An individual whose referral to GHQ was recommended after review of a relative
  • Tumour testing has identified a potential germline mutation in a familial cancer predisposition gene
  • Succinate dehydrogenase (SDH)-deficient renal carcinoma (regardless of age)
Category 3
(appointment within 365 calendar days)
  • A personal history of kidney cancer and one or more close relatives with kidney cancer diagnosed at age < 50 years in smokers, or at any age in non-smokers
  • Multifocal/bilateral renal tumour (benign or malignant) regardless of age
  • Renal cell carcinoma diagnosed at age < 40 years (regardless of histology)
  • Chromophobe renal cancer or renal oncocytoma diagnosed at age < 50 years
  • Hybrid oncocytic/chromophobe renal tumour (regardless of age)
  • A personal history of kidney cancer and a personal or family history of at least one of the following:
    • fibrofolliculomas
    • trichodiscomas
    • trichilemmomas
    • spontaneous pneumothorax
    • cutaneous leiomyomas
    • multiple uterine fibroids diagnosed at age < 40 years
    • paraganglioma or phaeochromocytoma
    • haemangioblastoma of the retina (retinal angioma) or central nervous system
    • pancreatic neuroendocrine tumour
    • multiple pancreatic cysts
  • Renal angiomyolipoma and personal history of at least one of the following:
    • multiple lesions
    • renal cysts
    • characteristic features of tuberous sclerosis complex
  • Cystic nephroma
  • Prostate cancer

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • As much detail as possible about the patient's personal of cancer including the following:
    • type/s of cancer
    • age at diagnosis
    • treatment including outcome
    • known relevant family history
  • Confirmation of OOHC (where appropriate) and contact details to send correspondence for OOHC
  • Relevant pathology including results of any genetic testing if performed and of immunohistochemistry for SDHA, SDHB and fumarate hydratase if done (if results are available on Auslab please indicate this on referral)
  • Relevant imaging

3. Additional referral information Useful for processing the referral

  • If the family is known to GHQ, include the GHQ reference number (GF) if known
  • Suspected von Hippel Lindau syndrome (VHL): Reports from previous ophthalmology review if done

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 3 March 2022

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