To establish pre-treatment levels at the time of definitive diagnosis (biopsy or resection). This gives the baseline for subsequent monitoring for recurrence.
Note: If the relevant marker was not raised at diagnosis, it cannot be used for subsequent monitoring.
Examples include
As part of surveillance where the marker was shown to be informative at diagnosis as above
Note that many non-malignant conditions, particularly abdominal inflammation/irritation leading to ascites, may result in misleadingly raised tumour marker levels at diagnosis
When a patient is merely suspected as having malignancy (eg unexplained weight loss), measurement of tumour markers is not indicated.
In female patient with a pelvic mass of likely ovarian origin, measurement of CA 125 is indicated.
For Primary Care only: Measurement of CA 125 is indicated in a female patient, as per NICE clinical guideline 122, with persistent (more than 12 times/month) abdominal distension (bloating), feeling full and/or loss of appetite, pelvic or abdominal pain, increased urinary urgency and/or frequency; women 50 or over with symptoms within the last 12 months that suggest IBS.
In a male patient with multiple bony metastases and no known primary site, measurement of PSA is indicated.
In a male patient under 65 with widespread (especially nodal and lung) metastases and no known primary site, measurement of alpha FP , Beta HCG and LDH is indicated.
In a patient with a liver mass suspicious for hepatoma, measurement of alpha FP is indicated.
AFP is indicated for the screening/surveillance of hepatoma in cirrhotics.
Alpha FP/Beta HCG/LDH for male patients under 65 with testicular cancer before malignancy is confirmed. In other circumstances, advice re tumour markers should be obtained if needed from the SPR or Consultant Oncologist on-call.
In other circumstances, advice re tumour markers should be obtained if needed from the SPR or Consultant Oncologist on-call.