What should I do if the physical examination finds that the tumor indicators are elevated?

Xiaoli told me that the previous 30 hours were the most painful 30 hours of her life.

The reason is simple: the results of the annual physical examination came out, and her tumor marker levels exceeded the standard.

In other words, she may have a tumor.

This is a very common annual physical examination.

Before the examination, Xiaoli was also very confident in her health. Except for the severe menstrual pain, there is nothing wrong with her.

But the results of the examination surprised her.

The normal value of the glycolyceroid 125 (CA125) criterion is 0-35U/mL, and her results are exceeded.

Of course, just one indicator exceeding the standard will not make her panic like this. But who makes CA125 a kind of "tumor marker"?

CA125 is the most commonly used indicator of ovarian cancer and one of the commonly used screening items for ovarian cancer. This was enough to scare Xiaoli not lightly. She said she thought a lot: her parents are in their sixties this year, and she is afraid that the elderly will hear bad news, and if she can't hold on, she will fall ill first. The child is still young this year, if it is lost to the husband, can the husband take care of it?

The big cat in the family, even if she came home late from overtime, would meow all over the house looking for someone. If she is hospitalized or even an accident occurs, who should the hungry and provocative cat be handed over? And her career, her dreams, seem to be in the face of this inspection report, becoming unworthy.

After 30 hours of anxiety, she came to my office and the first thing she said was: Doctor, can I still be saved?

What are tumor markers?

Among the many patients I have received, Xiaoli is certainly not the only one, and it cannot even be said to be rare.

Nowadays, tumor markers have become a routine item in the physical examination, and many people will find that their tumor markers are suddenly high, and then search for the meaning behind them, and immediately shiver.

One map recognizes all common tumor markers

Alpha-fetoprotein (AFP), the most sensitive and specific indicator for early diagnosis of primary liver cancer.

The elevation of carcinoembryonic antigen (CEA) is mainly seen in patients with middle and advanced tumors of adenoepithelial origin, and the positive rate of advanced tumors in the gastrointestinal tract is 80% to 90%.

Carbohydrate antigen 125 (CA125), the most commonly used indicator of ovarian cancer, especially the preferred marker of serous carcinoma, is also one of the common screening items for gynecological tumors and some gastrointestinal tumors.

Carbohydrate antigen 15-3 (CA15-3), the most important specific marker of breast cancer, is mainly used clinically as a monitoring indicator of breast cancer and is also a common marker of other gynecological tumors.

Carbohydrate antigen 19-9 (CA19-9) is of great significance for the differentiation and diagnosis of pancreatic cancer, and is also a common marker of gastrointestinal tumors such as stomach, colorectum and gallbladder.

Carbohydrate antigen 72-4 (CA72-4), one of the best tumor markers for diagnosing gastric cancer, has a high specificity for gastric cancer, and can be monitored in combination with CA19-9 and CEA.

Carbohydrate antigen 242 (CA242) has high sensitivity and specificity for pancreatic cancer and colorectal cancer.

Carbohydrate antigen 50 (CA50), the positive detection rate of pancreatic cancer and gallbladder cancer ranked first, followed by liver cancer, ovarian cancer, uterine cancer and so on.

CYFRA21-1 has extremely high diagnostic value in non-small cell lung cancer.

NSE, considered the preferred marker for monitoring small cell lung cancer, is also valuable for the diagnosis of neuroblastoma, melanoma, and neuroendocrine tumors.

SCC, an important marker of squamous epithelial cancer, helps to diagnose and monitor all cancers of squamous epithelial origin, such as squamous cell carcinoma that appears in the cervix, canal, lungs, trachea, esophagus, head and neck, etc.

PSA, the most sensitive marker for diagnosing prostate cancer, has an overall positive rate of more than 70%.

Tumor-specific growth factor (TSGF), an early auxiliary diagnostic index of broad-spectrum malignancies, can screen out dozens of tumors, and people in areas with high cancer incidence can perform this test once a year.

However, I noticed that Xiaoli had an old problem: dysmenorrhea, and when asked again, it turned out that she had endometriosis. Endometriosis, on the other hand, can cause an increase in CA125.

I comforted Xiaoli: "The elevation of tumor markers may be caused by tumors, or it may be caused by some benign diseases." It's too early to say tumors, and we need to make further differential diagnoses. "I gave Xiaoli two options: first, monitor this indicator once a month for 3 consecutive months; second, if the indicator continues to rise, or if it is particularly anxious, you can do a PET CT. Xiaoli chose the latter.

Pet CT results showed that Xiaoli found no suspicious lesions, and then continued to monitor for 3 months, CA125 indicators rose and fell, and finally combined with the results of various examinations, the tumor was ruled out.

Frequently asked questions about tumor markers

Although the ending can be called a happy ending, Xiaoli still has a few "can't figure it out".

For example:

You may be confused by the name tumor marker.

It is not originally used to diagnose tumors, but to monitor tumor recurrence, assess treatment prognosis, or to diagnose tumors in combination with other indicators.

The vast majority of tumor markers can be found in both benign and malignant tumors, as well as inflammation or some normal tissue cells.

In other words, cancer can cause it to rise, benign tumors and even some inflammation can cause it to rise.

Yes!

Malignant tumors are not necessarily "high", and benign tumors are not necessarily "not high".

There is a big difference in the growth rate and change trend of the two.

If the value of malignant tumors is elevated, it will generally cause a continuous increase, and the rise rate is relatively fast.

Elevations caused by benign diseases usually fluctuate up and down after a single value, with a slower increase.

No.

As mentioned earlier, tumor indicators cannot be used to diagnose tumors alone, in other words, when the indicators are normal, there may also be cases where malignant tumors or even metastasis are already present.

Therefore, the diagnosis of tumors needs to be comprehensively analyzed by means of medical history, symptoms, signs, imaging examination and other means.

need

Our judgment of the tumor requires comprehensive analysis, and it is an important point in the comprehensive analysis. The reasons are:

1 Easy to check

2 If there is an abnormality, benign and malignant analysis can be performed to capture clues to early tumors

3 If benign lesions that may evolve into tumors are found, such as lung nodules, intestinal polyps, etc., early intervention is also more beneficial to patients

4 In patients with already developed tumors, tumor markers are of great value in assessing the prognosis of treatment and monitoring recurrent metastasis.

With these answers, Xiao Li left the clinic with peace of mind.

She said that in the future, she will also include tumor markers in her annual physical examination. Before leaving the clinic, she asked: Director, can you give this a detailed whole, I am good to collect. Thus was born today's article. Finally, a more detailed interpretation table of common tumor markers is attached, which is recommended to be collected as a supplement to the previous article. Hopefully, it will also help you, as well as your friends around you.

Alpha-fetoprotein/APF

The most sensitive and specific indicator for early diagnosis of primary liver cancer.

Suitable for screening, but a negative does not completely exclude liver cancer.

It can reflect the size of the tumor to a certain extent, and can be used as an indicator to show the treatment effect and prognosis judgment.

Malignant teratomas, minority testicular cancers, and ovarian tumors may also cause elevated APF.

Some non-neoplastic diseases may also cause elevated APF, such as acute and chronic hepatitis and cirrhosis.

If the serum or amniotic fluid AFP is elevated in pregnant women, it is necessary to be vigilant for diseases such as spina bifida and anencephalopathy. In general, the AFP of malignant tumors will continue to increase, and the tumor index can be monitored once a month to observe dynamic changes.

Carcinoembryonic antigen / CEA

Elevated CEA is mainly seen in patients with middle and advanced tumors of glandular epithelial origin, and the positive rate of advanced tumors in the gastrointestinal tract is 80% to 90%.

CEA can also be significantly elevated in pancreatic cancer, lung cancer, breast cancer, etc. Non-malignant diseases such as intestinal inflammation, renal insufficiency, colon polyps, cirrhosis, smoking, and pregnancy are also elevated, but the values are not too high and the positive rate is low.

CEA assays can be used to guide tumor treatment and follow-up, especially sensitivity to tumor recurrence.

If CEA continues to increase after tumor treatment, there is a possibility of tumor remnants or recurrence after surgery.

Carbohydrate antigen 125 / CA125

The most commonly used indicator of ovarian cancer, especially the preferred marker of serous carcinoma, is also one of the commonly used screening items for gynecological tumors and some gastrointestinal tumors.

A drop in and rising levels of ovarian cancer after standard treatment suggests a recurrence of the tumor, and this signal is usually 3 to 4 months earlier than clinical and radiographic diagnosis.

Tubal carcinoma, endometrial cancer, cervical cancer, pancreatic cancer, and benign gynecological tumors can also cause elevated expression. Non-neoplastic diseases such as acute pancreatitis, endometriosis, pelvic inflammatory diseases, etc. also have this phenomenon.

Carbohydrate antigen 15-3 / CA15-3

CA15-3 is the most important specific marker of breast cancer, which is mainly used clinically as a monitoring index for breast cancer and is also a common marker for other gynecological tumors.

The sensitivity of breast cancer in early stage is low, but higher in metastatic breast cancer, and is also the best indicator to observe breast cancer recurrence and metastasis.

It is also seen in liver cancer, lung cancer, ovarian cancer, etc.

Carbohydrate antigen 19-9 / CA19-9

It is of great significance for the differentiation and diagnosis of pancreatic cancer, and is also a common marker of gastrointestinal tumors such as stomach, colorectum and gallbladder.

Low preoperative levels often indicate a better prognosis, and if CA19-9 is persistently elevated after surgery, it indicates tumor recurrence.

Benign diseases such as cholelithiasis, cholecystitis, hepatitis, and pancreatitis can also cause elevated indicators and need to be differentiated.

Carbohydrate antigen 72-4 / CA72-4

CA72-4 is one of the common tumor markers for diagnosing gastric cancer, which has high specificity for gastric cancer and can be combined with CA19-9 and CEA.

The dynamic change of CA72-4 level is closely related to gastric cancer infiltration, liver metastasis, peritoneal metastasis, etc., which is a good indicator to evaluate the progression and treatment effect of gastric cancer, and can also predict the recurrence of gastric cancer earlier.

Carbohydrate antigen 242 / CA242

When a tumor occurs in the digestive tract, the content of CA242 will increase, which has a high sensitivity and specificity for pancreatic cancer and colorectal cancer.

Lung cancer and breast cancer patients will also have positive results.

If combined with CEA, sensitivity will increase further.

Inflammation in the body and taking antibiotics may also elevate it, requiring further diagnosis

Carbohydrate antigen 50 / CA50

It is a commonly used carbohydrate antigen tumor marker.

CA50 has a certain positive detection rate in pancreatic cancer, gallbladder cancer, liver cancer, ovarian cancer, and uterine cancer.

The concentration of CA50 in gastric juice in patients with atrophic gastritis changes significantly. Atrophic gastritis itself is not malignant, but is a high-risk precancerous stage.

Pancreatitis, colitis, and pneumonia can also cause an increase in CA50, which returns to normal when the inflammation subsides.

CYFRA21-1

It has high diagnostic value in non-small cell lung cancer, and the compliance rate of CYFRA21-1 in the diagnosis of non-small cell lung cancer in combination with CEA can reach 78%.

Some benign lung diseases, gynecological disorders, and renal insufficiency may be mildly elevated.

NSE

NSE is considered the preferred marker for monitoring small cell lung cancer. When small cell lung cancer recurs, the NSE rises earlier than the clinical symptoms by about 4 to 12 weeks.

NSE is also valuable in the diagnosis of neuroblastoma, melanoma, and neuroendocrine tumors.

Transient elevations are also present in the general population, requiring a differential diagnosis.

SCC

SCC is an important marker of squamous epithelial carcinoma, and the content in normal tissues is very small, so the specificity is good.

Helps in the diagnosis and monitoring of all cancers of squamous epithelial origin, such as squamous cell carcinomas that appear in the cervix, canal, lungs, trachea, esophagus, head and neck, etc.

In primary cervical cancer, its serum level is associated with tumor progression, degree of aggression and metastasis, in addition, the concentration of SCC in 50% of patients with recurrence is higher than that of clinical diagnosis for 2-5 months, which can be used as an effective indicator to monitor cervical cancer recurrence.

About 5% of healthy people experience a mild increase in this indicator.

Benign lung disease, skin disease, and kidney disease can also cause elevated indicators.

PSA

One of the most sensitive markers for diagnosing prostate cancer and an important indicator of monitoring the efficacy of prostate cancer treatment, such as re-escalation after the concentration of PSA after surgery does not decrease or decreases, tumor recurrence or metastasis should be considered.

Numerical increases may also occur in prostatitis and prostate enlargement.

EBV virus antibody / EBV-VCA

Epstein-Barr virus antibodies are of great significance for the screening and clinical diagnosis of high-risk populations of nasopharyngeal cancer. It can also be used in the diagnosis of infectious mononucleosis and lymphoma.

A positive indication of infection with Epstein-Barr virus (half a year ago or even earlier) does not mean that nasopharyngeal cancer will inevitably occur. However, the risk of future NASOPHARyngeal cancer is indeed higher for positive patients, and it is recommended to strengthen follow-up.

TSGF

Internationally recognized tumor marker, when cells become cancerous, their metabolism is disturbed, which causes an increase in the content of body fluids.

Early adjuvant diagnostic indicators of broad-spectrum malignancies can screen out up to dozens of tumors, and people in areas with high cancer incidence can perform this test once a year.

Benign diseases such as acute inflammation and collagen disease may also have a transient increase in TSGF, but the level will decrease after treatment or natural recovery.

Source | Junkang Science Club