Haematuria in Malignancy
Haematuria - blood in the urine - may range from an incidental laboratory finding to life‑threatening haemorrhage. In adults it is an important red flag for urological malignancy (most commonly bladder, renal and upper‑tract urothelial cancers) and requires a systematic emergency assessment: immediate stabilisation when needed, focused investigations to guide urgency, clear documentation of risk factors and exposure history, and prompt referral on the suspected‑cancer pathway when indicated (NICE NG12, NG2, NG256).
Definitions
- Visible (macroscopic) haematuria: blood visible to the patient or clinician in the urine.
- Non‑visible (microscopic) haematuria: blood detected on urine dipstick or microscopy without visible discoloration.
Common malignancies presenting with haematuria
- Bladder cancer (most frequent cause of visible haematuria).
- Renal cell carcinoma and other primary renal tumours.
- Upper urinary tract urothelial carcinoma (renal pelvis/ureter).
- Prostate or pelvic tumours (less commonly primary causes but may erode vessels).
Key pathophysiology and risk factors
Haematuria arises from tumour ulceration, friable neovascular tissue, tumour‑related obstruction with secondary infection, or tumour erosion into vessels. Always elicit and document risk factors because referral thresholds and investigation urgency are age‑based and exposure‑dependent:
- Age (risk rises markedly with increasing age).