Tumour Marker Use in Primary Care

Written by Craig Webster on 11 October 2016.

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
CEA	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
CA19-9	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.
CA125	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
CA15-3	Monitoring breast cancer	Lung, colon, ovary	Raised in benign liver, breast, ovarian disease
AFP	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
PSA	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
hCG	Diagnosis and monitoring of germ cell tumours and gestational trophoblastic neoplasia	Lung	Raised in pregnancy Transiently elevated with cannabis use
LDH	Diagnosis and monitoring of germ cell tumours		Elevated in cardiac disease and benign liver disease Elevated in some anaemias relating to non-malignant disease

Created on 11 October 2016.
Last updated on 15 August 2018.