Clinical Review

Serum tumour markers: how to order and interpret them

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3527 (Published 22 September 2009) Cite this as: BMJ 2009;339:b3527
  1. C M Sturgeon, consultant clinical scientist1,
  2. L C Lai, professor of clinical biochemistry and metabolic medicine2,
  3. M J Duffy, professor of pathology and laboratory medicine34
  1. 1Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA
  2. 2Faculty of Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
  3. 3Department of Pathology and Laboratory Medicine, St Vincent’s University Hospital, Dublin 4, Ireland
  4. 4UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
  1. Correspondence to: C M Sturgeon C.Sturgeon{at}ed.ac.uk

Summary points

  • Tumour markers can contribute usefully to patient management, but awareness of their limitations is essential

  • The main application of tumour markers is in monitoring

  • Measurement of α fetoprotein and human chorionic gonadotrophin is mandatory in the management of germ cell tumours

  • Carcinoembryonic antigen (CEA) is recommended for postoperative follow-up of patients with stage II and III colorectal cancer if further surgery or chemotherapy is an option

  • Prostate specific antigen (PSA) may be used for detecting disease recurrence and monitoring treatment in patients with prostate cancer

  • In some high risk patients, measurement of α fetoprotein, CA125, or CA19-9 may aid early detection of hepatocellular carcinoma, ovarian cancer, or pancreatic cancer, respectively

  • Opportunistic screening with panels of tumour markers is not helpful, nor is measurement of CA125 in men or PSA in women

Tumour markers are molecules that may be present in higher than usual concentrations in the tissue, serum, urine, or other body fluids of patients with cancer.1 2 3 Serum tumour markers may aid cancer diagnosis, assess prognosis, guide choice of treatment, monitor progress during and after treatment, and/or be used as screening tests. Conservative estimates suggest that in the United Kingdom alone close to 15 million such measurements are made each year.

If tumour markers are requested and interpreted correctly, they undoubtedly help clinical management. Somewhat alarmingly, however, a recent audit in a single Greek hospital found that only about 10% of requests for tumour markers were appropriate.4 The cost of inappropriate testing of tumour markers was estimated to be about €23 974 (£21 000; $35 000) a month, even without including the cost of unnecessary second level follow-up investigations such as colonoscopy and ultrasonography.4 However, awareness of the limitations of tumour markers is crucial not only because of the economic implications of their misuse but even more importantly …

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