Practice Rational Testing

Appropriate requesting of serum tumour markers

BMJ 2009; 339 doi: (Published 22 September 2009) Cite this as: BMJ 2009;339:b3111
  1. Eric S Kilpatrick, honorary professor in clinical biochemistry1,
  2. Michael J Lind, foundation professor of oncology 2
  1. 1Department of Clinical Biochemistry, Hull Royal Infirmary, Hull HU3 2JZ
  2. 2Academic Department of Oncology, Castle Hill Hospital, Cottingham
  1. Correspondence to: ES Kilpatrick Eric.Kilpatrick{at}
  • Accepted 14 April 2009

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

The patient

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 serum, and a liver biopsy confirmed cirrhosis. The history included no obvious risk factors for the hepatitis C infection.

What should the next investigation have been?

This case highlights the limitations of using most serum tumour markers to …

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