Published 22 September 2009, doi:10.1136/bmj.b3111
Cite this as: BMJ 2009;339:b3111

Practice

Rational Testing

Appropriate requesting of serum tumour markers

¹ Department of Clinical Biochemistry, Hull Royal Infirmary, Hull HU3 2JZ, ² Academic Department of Oncology, Castle Hill Hospital, Cottingham

Tumour markers have a limited role, if any, in initial investigations, but they can be important in following up patients with known malignancy

The first 150 words of the full text of this article appear below.

A 54 year old woman presented to her general practitioner with swelling of her abdomen, general malaise, and weight loss of about 5 kg during the preceding three months. On examination, she had a slightly distended abdomen and evidence of ascites. No masses could be felt.

The general practitioner ordered routine biochemistry tests as well as requesting CA125, CEA (carcinoembryonic antigen), and CA19.9 tumour markers, as he believed these would help him judge the likelihood of ovarian, colonic, and pancreatic cancers. The results of these and routine biochemistry are shown in the table.

View this table:   Results of routine biochemistry

 
An urgent gynaecological oncology referral was arranged to exclude ovarian cancer. Both abdominal ultrasound and computerised tomography confirmed ascites, but showed no ovarian mass or intra-abdominal malignancy. However, the liver was atrophic and showed a diffuse surface irregularity. Subsequent testing found hepatitis C infection with hepatitis C virus RNA detectable in the . . . [Full text of this article]

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