Serum tumour markers: how to order and interpret them

The clinical review by Sturgeon et al. (1) addresses an important
issue for both patients and clinicians, as well as for stakeholders in
health care systems. Although the list of non cancer-related conditions
causing elevation of serum tumour markers is already long, we believe it
is of importance to remember that CA-125 can be elevated in patients with
active pulmonary (2) and extra-pulmonary tuberculosis (3). The prevalence
of tuberculosis is increasing in most developed countries, and cases are
described in which this disease mimics ovarian cancer (4): in patients
with CA-125 elevation, to overlook tuberculosis as a potential cause may
cause harmful delays in making the correct diagnosis. Indeed, given the
difficulty of making a definitive diagnosis of tuberculosis, CA-125 may be
considered a useful tool in the diagnostic workup when the suspect for
this disease is high.

1. Sturgeon CM, Lai LC, Duffy MJ. Serum tumour markers: how to order
and interpret them. BMJ 2009<339:b3527.

2. Yilmaz A, Ece F, Bayramgürler B, Akkaya E, Baran R. The value of
Ca 125 in the evaluation of tuberculosis activity. Respir Med 2001; 95:666
-9.

3. O'Riordan DK, Deery A, Dorman A, Epstein OE. Increased CA 125 in a
patient with tuberculous peritonitis: case report and review of published
works. Gut 1995; 36:303-5.

4. Bilgin T, Karabay A, Dolar E, Develioðlu OH. Peritoneal
tuberculosis with pelvic abdominal mass, ascites and elevated CA 125
mimicking advanced ovarian carcinoma: a series of 10 cases. Int J Gynecol
Cancer 2001; 11:290-4.

Competing interests:
None declared