What should I do if the physical examination finds that the tumor markers are elevated? | doctor's business card

Does elevated tumor markers mean cancer?

If the tumor markers are abnormal, how should I deal with them?

Which tumor markers should be paid special attention to, and which indicators should not be too nervous?

What are tumor markers

Tumor markers are substances released by tumor cells or normal cells after being stimulated by tumors. It can be detected in blood, body fluids and tissues as one of the auxiliary indicators for diagnosing tumors.

Does elevated tumor markers mean cancer?

Although tumor markers are associated with tumors, they are not the only ones that secrete these markers.

Other diseases can also cause mild elevation of tumor markers, such as tuberculosis.

Some tumor markers are highly specific, and a mild elevation may indicate a tumor.

Some tumor markers have low specificity, and several markers are elevated at the same time or repeatedly.

The values of tumor markers detected by different hospitals and different devices may vary, and sometimes there may even be errors.

What to do if you find elevated tumor markers

Most people find abnormalities in tumor markers during a physical examination. Once you find that the tumor markers are elevated, do not blindly go to the examination, let alone listen to rumors, take your own medication, and should do a specific examination according to the advice of the doctor of the tumor-related department (such as the department of oncology). Please judge its severity based on the following circumstances:

1. Highly specific markers such as carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) should be highly valued even if they are mildly elevated.

2. When other tumor markers are elevated, it can be rechecked 1 to 2 times to determine obvious abnormalities before visiting the doctor.

3. When there are several tumor markers elevated at the same time, attention should be paid to and medical treatment and examination should be examined.

4. Although the abnormal value of tumor markers is not too high, after repeated re-examination, it is found that the indicators are getting higher and higher, and it is necessary to check in time.

5. When tumor markers are elevated and accompanied by physical abnormalities, they need to be checked in time.

6. When tumor markers are elevated and accompanied by relevant risk factors, they need to be checked in time.

Which tumor markers should be paid special attention to

Which tumor markers can "alert" cancer to which of your physical abnormalities are related? Which tumor markers are easy to "fake alarms" and are related to which of your physical conditions? What tests will your doctor usually prescribe for you? Let's take a look.

1

Alpha-fetoprotein (AFP)

High specificity. Elevated disease is seen in liver cancer or cholangiocarcinoma, but also in teratoma, testicular cancer, and ovarian cancer. Note: Rarely, pregnancy, hepatitis may also cause elevated AFP.

Abnormal physical manifestations: hepatitis B and C virus carriers need long-term monitoring, if the AFP is elevated with symptoms such as yellow muscle thinness, bloating and anorexia, nausea and vomiting, liver cancer should be vigilant.

Recommended tests: liver ultrasound, or liver tumor-specific magnetic resonance, or epigastric enhanced computed tomography (CT), and, if necessary, puncture biopsy.

2

Carcinoembryonic antigen (CEA)

High specificity. Elevated disease is seen in bowel cancer, stomach cancer, lung cancer, pancreatic cancer, thyroid cancer, breast cancer, urinary tract tumors, etc. Note: The specificity of this indicator is very high, and even if there is a slight elevation, it is necessary to see a doctor for further screening in time.

Physical abnormalities: middle-aged and elderly smokers, cough, sputum with blood; long-term anorexia and weight loss; stool with blood or pus blood.

Recommended examinations: gastrointestinal endoscopy, chest CT, abdominal CT.

3

Carbohydrate antigen 125 (CA125)

High specificity. Elevated levels can be seen in gynecological tumors (ovarian cancer, endometrial cancer), but also in cholangiocarcinoma, pancreatic cancer, breast cancer, lung cancer, etc. Caution: May also be elevated during pregnancy, menstruation, pelvic infections, tuberculosis infections, and chronic inflammation of the hepatobiliary pancreas.

Physical abnormalities: lower abdominal distension, pain, abdominal swelling, if the tuberculosis infection leads to elevation, there may be symptoms such as low-grade fever in the afternoon, night sweats in the middle of the night, cough and so on.

Recommended examinations: uterine adnexal ultrasound, full abdominal enhancement CT, tuberculin test (PPD).

4

Prostate-specific antigen (PSA)

High specificity. Elevated levels can be seen in prostate cancer and can also be seen in other urinary tract tumors. Note: In rare cases, prostatic hyperplasia or prostatitis may also be elevated.

Physical abnormalities: poor urination, pain in the lower abdomen. If the prostate cancer has metastasized bone, patients may also have bone pain.

Recommended examination: transrectal prostate ultrasound, or MRI of the prostate, and, if necessary, puncture biopsy.

5

Carbohydrate antigen 19-9 (CA19-9)

High specificity. Elevated in pancreatic cancer, but also in cholangiocarcinoma, gastrointestinal cancer, etc. Note: In extremely rare cases, chronic inflammation of the hepatobiliary pancreas can also lead to mild elevation.

Physical abnormalities: vague pain in the epigastric region, emaciation and anorexia.

Recommended examination: abdominal enhancement CT or ultrasound. Note: Abdominal ultrasound is easy to miss for small tumors.

6

Carbohydrate antigen 15-3 (CA15-3)

Low specificity. Elevated in advanced breast cancer. Note: If only this one is mildly elevated, there is no need to be nervous, but the indicator must be reviewed several times.

Recommended test: Mammography. If there is a previous history of breast cancer, a systemic CT should be done to evaluate for metastases.

7

Carbohydrate antigen 72-4 (CA72-4)

Low specificity. Elevated in gastrointestinal tumors. Note: If this alone is mildly elevated, it generally does not indicate a tumor.

Recommended examination: abdominal ultrasound or abdominal enhancement CT.

Author | Department of Oncology, Southwest Hospital of Army Military Medical University

Deputy Chief Physician Yu Songtao

Audit | Expert of the National Health Science Popularization Expert Database

Liang Houjie, chief physician of the Department of Oncology, Southwest Hospital of the Army Military Medical University

Planning | Tan Jia

Edit | Liu Yang