Suspected bladder cancer — MSRA MCQ

Correct answer: C — Refer using a suspected cancer pathway for bladder cancer

This patient requires a suspected cancer pathway referral for bladder cancer. She is aged 60 years or over and has unexplained non-visible haematuria with dysuria. The repeated negative urine cultures make bacterial urinary tract infection an inadequate explanation for her symptoms and haematuria. A normal white cell count does not alter the indication because NICE specifies dysuria or a raised white cell count; both are not required. Repeating dipstick testing before referral is inappropriate because the qualifying presentation is already established. Non-urgent referral is recommended for people aged 60 years or over with recurrent or persistent unexplained urinary tract infection, but this patient has no culture-confirmed UTI and meets criteria for urgent suspected cancer referral instead. Empirical antibiotics would be reasonable initially if UTI were clinically likely, but repeated sterile cultures and persistent haematuria now require investigation for malignancy. Primary-care imaging may be incorporated into local pathways, but it should not delay the suspected cancer pathway referral.

Reference: NICE NG12: Suspected cancer: recognition and referral — recommendations organised by site of cancer (Updated 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer NICE NG12: Recommended actions organised by symptom and findings of primary care investigations (Updated 2026) — https://www.nice.org.uk/guidance/NG12/chapter/recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations