Tumour Marker Requesting: Guidance for Primary Care

Scottish Clinical Biochemistry Network
www.clinicalbiochemistry.scot.nhs.uk

PSA (prostate specific antigen) MEN ONLY
Relevant cancer:Prostate cancer

Typical clinical presentations that might warrant measurement: Frequency, urgency, nocturia, dysuria, acute retention, back pain, weight loss, anaemia, prostate enlargement.

Caution – other conditions marker may be raised in include: Benign prostatic hyperplasia, urinary tract infection, prostatitis and after catheterisation.

Caution – other malignancies marker may be raised in include: None known.

Notes:
• Take samples prior to digital rectal examination and >6 weeks after invasive procedures (e.g. prostatectomy)
• Objective information for asymptomatic men requesting PSA measurement is available at www.scotland.gov.uk/Resource/Doc/1094/0088915.pdf

CA125 (cancer antigen 125) WOMEN ONLY
Relevant cancer: Ovarian cancer

Typical clinical presentations that might warrant measurement: Pelvic mass; persistent (more than 12 times / month) and continuous or worsening unexplained abdominal or urinary symptoms, abdominal bloating, irritable bowel symptoms, increased urinary frequency.

Caution – other conditions marker may be raised in include: Pregnancy, menstruation, endometriosis, benign ascites, acute hepatitis, chronic renal failure, heart failure, pleural effusion and others.

Caution – other malignancies marker may be raised in include: Breast, cervical, endometrial, hepatocellular, lung, pancreatic and other cancers.

Paraproteins (M-Protein)
Relevant cancers: B-cell proliferative disorders (e.g. multiple myeloma, AL-amyloidosis, Waldenstrom’s macroglobulinaemia and some low grade non-Hodgkin’s lymphomas).

Typical clinical presentations that might warrant measurement: Unexplained anaemia, bone pain, weakness or fatigue, raised ESR, viscosity or abnormal globulins, hypercalcaemia, renal failure,  pontaneous fractures and/or recurrent infections.

Caution – other conditions where paraproteins may be present: Conditions, usually autoimmune or infective, in which there is a chronic stimulation of the immunoglobulin response, monoclonal gammopathy of unknown significance (MGUS), and following peripheral blood stem cell transplant (PBSCT), with an increasing prevalence in the elderly.

Notes: When requesting paraprotein investigation please send both a serum and a urine specimen.

Tumour Marker Requesting: Guidance for Primary Care

Top tips for optimal requesting:
• The need for informed consent should be considered.
• Opportunistic screening with panels of tumour markers is not helpful. CA125 should not be measured in men nor PSA in women.
• Serial results are usually most useful, as the main application of serum tumour markers is for monitoring patients with a previously diagnosed malignancy.
• Provision of brief and relevant clinical information on the request form is very helpful to the laboratory.
• AFP, hCG, CEA, CA15-3 and CA19-9 should only be requested as and when advised by the specialist secondary care team. This should be indicated on the request form.

Useful resources:
Laboratory staff are always pleased to provide advice on test requesting and interpretation.

For further information please see the following:

General:
• ‘Serum tumour markers: how to order and interpret them’
http://tinyurl.com/TumourMarkers
• Scottish Referral Guidelines for Suspected Cancer
www.healthcareimprovementscotland.org
• Information about laboratory testing
www.labtestsonline.org.uk

Specific:
• PSA: NHS Scotland Prostate Cancer Risk Management Programme
www.scotland.gov.uk/Resource/Doc/1094/0088915.pdf
• CA125: SIGN Guideline 135 - Management of epithelial ovarian cancer
www.sign.ac.uk/assets/sign135_2018.pdf
• Paraproteins: http://tinyurl.com/Paraproteins