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Pelvic CRT Late Effects — SCE Medical Oncology MCQ

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HardGynaecological CancersPelvic CRT Late EffectsSCE Medical Oncology

A 58-year-old woman treated with pelvic chemoradiotherapy for cervical cancer 8 years ago develops painless visible haematuria. Urine culture is negative and renal function is stable. What is the safest next step?

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Correct answer: C — Arrange suspected-cancer pathway urological assessment rather than attributing the bleeding to radiation cystitis

Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E

C is correct. NICE recommends a suspected-cancer pathway referral for unexplained visible haematuria in adults aged 45 or over. Previous pelvic radiotherapy makes radiation cystitis plausible, but it also creates late urinary morbidity and does not remove the need to exclude bladder or renal malignancy. A starts a specialist treatment before establishing the diagnosis. B delays assessment despite a negative culture. D uses a gynaecological follow-up pathway that does not investigate the urinary tract. E suppresses bleeding while delaying the indicated evaluation. The eventual work-up can distinguish malignancy, stones, radiation injury and other causes.

Reference: NICE NG12 suspected-cancer actions by symptom: https://www.nice.org.uk/guidance/ng12/chapter/Recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations