Tumour Marker Use in Primary Care

In the last 5 years requests for tumour marker tests from Primary Care have more than doubled. This high use in Primary Care is worrying because the majority of tumour markers (eg. CEA, CA19-9) are neither specific nor sensitive enough for use in the diagnosis of malignancy. See this link for a summary of the main tumour markers, their uses and limitations.

The main use for tumour markers is in monitoring disease progression, treatment or recurrence of a histologically diagnosed cancer. A recent audit of Primary Care requests for tumour markers found that only 9% of CEA and 4% of CA19-9 were requested for these reasons; the rest being for non-specific symptoms.

In contrast to the above, CA125 and PSA do have use in diagnosis of their related cancers, however it should also be noted that these are still only a diagnostic aid and should be used with caution as both can be raised in a number of other benign conditions (see table). Please click the relevant links below of links to guidelines relating to their use in Primary Care.

CA125 link https://pathways.nice.org.uk/pathways/ovarian-cancer

PSA link https://www.gov.uk/guidance/prostate-cancer-risk-management-programme-overview

For symptoms and referral guidelines of other malignancies see the NICE Suspected Cancer Recognition and Referral guidelines. http://pathways.nice.org.uk/pathways/suspected-cancer-recognition-and-referral

You can also use the search bar or test database on this website to find more specific information on the use of each tumour marker.

Tumour marker

Main application

Other tumour elevations

Other limitations


Monitoring colorectal adenocarcinomas

Breast, lung, gastric, mesotheliomas, oesophageal and pancreatic

Raised in smokers

Raised in other benign renal, liver, lung or GI disease

Poor sensitivity in early disease and may be absent/low in poorly differentiated tumours


Monitoring pancreatic carcinoma


Raised in obstructive jaundice, cholestasis, cirrhosis, pancreatic hepatitis and non-malignant GI disease.

Not present in those negative for the Lewis blood group determinant.


Monitoring ovarian carcinoma


Raised in patients with ascites, pleural effusions or free fluid in the pelvis

Raised in patients with congestive heart failure

Raised in benign renal and liver disease and other adenocarcinomas

Mildly raised in menstruation and the first two trimesters of pregnancy

Can be raised in endometriosis


Monitoring breast cancer

Lung, colon, ovary

Raised in benign liver, breast, ovarian disease


Diagnosis and monitoring of hepatocellular carcinoma and germ cell tumours

Gastric and other GI (oesophageal, pancreatic)

Raised in pregnancy and neonates

Raised in benign liver disease


Diagnosis and monitoring of prostate carcinoma


Also elevated in benign prostatic conditions

Increases with age (as prostate size increases)

Elevated in UTI, catheterisation, prostatitis or other prostate manipulation


Diagnosis and monitoring of germ cell tumours and gestational trophoblastic neoplasia


Raised in pregnancy

Transiently elevated with cannabis use


Diagnosis and monitoring of germ cell tumours


Elevated in cardiac disease and benign liver disease

Elevated in some anaemias relating to non-malignant disease

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The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
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