On Mon, 15 Apr 2002 12:16:16 +0100, Smith, Helen
<[log in to unmask]> wrote:
>Dear All,
>
>I've been asked to suggest minimum frequencies for assaying various
>endocrine and tumour markers in our department. I have realised that
>although I have been using as my rule of thumb, that tumour markers should
>not be assayed more frequently than once for each of their respective half
>lives, I have no evidence to back up this feeling.
>
>Can anyone point me in the direction of some suggestions/guidelines for how
>frequently one should measure: AFP, CEA, CA125,CA153, CA199, PSA and HCG ?
>I'm thinking in terms of monitoring progression, not diagnostic uses.
>
>Thanks in anticipation of help
>
>Helen Smith
>Clinical Biochemistry
>The Royal Free Hospital
>
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One aspect that is important when considering frequency of measuring tumour
markers, apart from t1/2 etc., is the value of the result to the clinician
and the patient. For example, CA-125 will rise as a reflection of
recurrence of disease following surgery for ovarian cancer. My
understanding is that at present there are no treatment options until there
is clinical evidence of the recurrence. The dilemma is that should CA-125
be measured at all in this circumstance, and if it is should the depressing
news of rising values (about which nothing will be done in terms of
treatment) be made known to the patient. For some oncologists managing this
clinical situation the answer might be rarely or not at all, for others it
might be monthly. For a discussion on this see Fleming - Playing the
waiting game ....Scottish Medical Journal 2001;46
(3):81-3.
My own view is that frequency of tumour marker measurements requires close
consultation with the the clinical users as to how they apply each marker
to each of the various types of clinical problem they deal with. Such
discussions naturally then bring in the lab view re t1/2, biological
variation, imprecision etc if relevant to the frequency being proposed.
Regards,
Graham White
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