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Cancer Diagnosis: Laboratory Tests

How is cancer diagnosed?

There is no single test that can accurately diagnose cancer. The complete evaluation of a patient usually requires a thorough history and physical examination along with diagnostic testing. Many tests are needed to determine whether a person has cancer, or if another condition (such as an infection) is mimicking the symptoms of cancer. The doctor forms a list of possible diagnoses that can explain the symptoms and complaints, and then orders testing to confirm a diagnosis and/or to exclude other potential diagnoses. Effective diagnostic testing is used to confirm or eliminate the presence of disease, monitor the disease process, and plan for and evaluate the effectiveness of treatment. In some cases, it is necessary to repeat testing when a person’s condition has changed, if a sample collected was not of good quality, or an abnormal test result needs to be confirmed. Diagnostic procedures for cancer may include imaging, laboratory tests (including tests for tumor markers), tumor biopsy, endoscopic examination, surgery, or genetic testing.

What are the different types of laboratory tests?

Clinical lab testing uses chemical processes to measure levels of chemical components in body fluids and tissues. The most common specimens used in clinical lab tests are blood and urine. Many different tests exist to detect and measure almost any type of chemical component in blood or urine. Components may include blood glucose, electrolytes, enzymes, hormones, lipids (fats), other metabolic substances, and proteins. The following are some of the more common laboratory tests:

  • Blood tests. A variety of blood tests are used to check the levels of substances in the blood that indicate how healthy the body is and whether infection is present. For example, blood tests revealing elevated levels of waste products, such as creatinine or blood urea nitrogen (BUN), indicate that the kidneys are not working efficiently to filter those substances out. Other tests check the presence of electrolytes--chemical compounds such as sodium and potassium that are critical to the body's healthy functioning. Coagulation studies determine how quickly the blood clots.

    A complete blood count (CBC) measures the size, number, and maturity of the different blood cells in a specific volume of blood. This is one of the most common tests performed. Red blood cells are important for carrying oxygen and fighting anemia and fatigue; the hemoglobin portion of the CBC measures the oxygen-carrying capacity of the red blood cells while the hematocrit measures the percentage of red blood cells in the blood. White blood cells fight infection. Increased numbers of white blood cells, therefore, may indicate the presence of an infection. Platelets prevent the body from bleeding and bruising easily.
  • Urinalysis. Urinalysis breaks down the components of urine to check for the presence of drugs, blood, protein, and other substances. Blood in the urine (hematuria) may be the result of a benign (noncancerous) condition, but it can also indicate an infection or other problem. High levels of protein in the urine (proteinuria) may indicate a kidney or cardiovascular problem.
  • Tumor markers. Tumor markers are substances either released by cancer cells into the blood or urine or substances created by the body in response to cancer cells. Tumor markers are used to evaluate how well a patient has responded to treatment and to check for tumor recurrence. Research is currently being conducted on the role of tumor markers in detection, diagnosis, and treatment of cancers, and new tumor markers are continuously being introduced.

    Tumor markers are useful in identifying potential problems, but in most cases they must be used along with other tests for the following reasons:
    • Cells other than cancer cells also produce tumor markers. People with benign conditions may also have elevated levels of these substances in their blood.
    • Not every person with cancer has tumor markers.
    • Some tumor markers are not specific to any one type of cancer.
    • Sometimes, as the cancer becomes more malignant, it stops producing tumor markers, making it appear that the tumor has shrunk.

The following is a brief description of some of the more useful tumor markers:

  • Prostate-specific antigen (PSA). PSA is always present in low concentrations in the blood of adult males. An elevated PSA level in the blood may indicate prostate cancer, but other conditions such as benign prostatic hyperplasia and prostatitis can also raise PSA levels. PSA levels are used to evaluate how a patient has responded to treatment and to check for tumor recurrence.
  • CA 125. Ovarian cancer is the most common cause of elevated CA 125, but cancers of the uterus, cervix, pancreas, liver, breast, lung, and digestive tract can also raise CA 125 levels. Several noncancerous conditions can also elevate CA 125. CA 125 is used primarily to monitor the treatment of ovarian cancer.
  • Carcinoembryonic antigen (CEA). CEA is normally found in small amounts in the blood. Colorectal cancer is the most common cancer that raises this tumor marker. Several other cancers can also raise levels of carcinoembryonic antigen.
  • Alpha-fetoprotein (AFP). AFP is normally elevated in pregnant women since it is produced by the fetus. However, AFP is not usually found in the blood of adults. In men, and in women who are not pregnant, an elevated level of AFP may indicate liver cancer or cancer of the ovary or testicle. Noncancerous conditions may also cause elevated AFP levels.
  • Human chorionic gonadotropin (HCG). HCG is another substance that appears normally in pregnancy and is produced by the placenta. If pregnancy is ruled out, HCG may indicate cancer in the testis, ovary, liver, stomach, pancreas, and lung. Marijuana use can also raise HCG levels.
  • CA 19-9. This marker is associated with cancers in the colon, stomach, and bile duct. Elevated levels of CA 19-9 may indicate advanced cancer in the pancreas, but it is also associated with noncancerous conditions, including gallstones, pancreatitis, cirrhosis of the liver, and cholecystitis.
  • CA 15-3. This marker is most useful in evaluating the effect of treatment for women with advanced breast cancer. Elevated levels of CA 15-3 are also associated with cancers of the ovary, lung, and prostate, as well as noncancerous conditions, such as benign breast or ovarian disease, endometriosis, pelvic inflammatory disease, and hepatitis. Pregnancy and lactation also can raise CA 15-3 levels.
  • CA 27-29. This marker, like CA 15-3, is used to follow the course of treatment in women with advanced breast cancer. Cancers of the colon, stomach, kidney, lung, ovary, pancreas, uterus, and liver may also raise CA 27-29 levels. Noncancerous conditions associated with this substance are first trimester pregnancy, endometriosis, ovarian cysts, benign breast disease, kidney disease, and liver disease.
  • Lactate dehydrogenase (LDH). LDH is a protein that normally appears throughout the body in small amounts. Many cancers can raise LDH levels, so it is not useful in identifying a specific kind of cancer. Measuring LDH levels can, however, be helpful in monitoring treatment for cancer. Noncancerous conditions that can raise LDH levels include heart failure, hypothyroidism, anemia, and lung or liver disease.
  • Neuron-specific enolase (NSE). NSE is associated with several cancers, but it is used most often to monitor treatment in patients with neuroblastoma or small cell lung cancer.

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