Inappropriate requests for tumour markers are on the
increase. Possible ways to curb the problem:

1. Proper education of the requesters.
2. Create some local guidelines for requesting tumour
markers, involving the oncologists and other
appropriate clinicians in their production.
3. Screen all tumour markers requests for 
appropriateness by senior lab staff and reject
inappropriate requests after discussion with the
requesting clinician.
4. Put some computer generated guided comments with
each report.

As most labs are starved for resources, 1 & 3 can not
be done effectively. 

regards

Mohammad



--- "Hallworth Mike (RLZ)" <[log in to unmask]>
wrote:

> Thanks Cathryn. For the record, the original result
> went out with our
> standard CA125 comment, which reads:
> "Tumour markers are NOT diagnostic, and are of most
> use in monitoring
> response to treatment and the early detection of
> relapse"
> 
> To be fair also, there has been no misdiagnosis of
> malignancy in this case -
> just a lot of confusion before they thought to ask
> us about it!
> 
> Mike
> 
> -----Original Message-----
> From: Corns, Cathryn
> [mailto:[log in to unmask]] 
> Sent: 02 June 2005 10:44
> To: [log in to unmask]
> Subject: Re: Non-specific CA125
> 
> 
>  Having resisted the temptation do become involved
> in this debate I am now
> moved to put finger to keyboard.
> 
> In my view tumour markers only have a role in the
> possible diagnosis of
> malignancy if the results are being scrutinised by
> an oncologist, who with
> their clinical judgement can make sensible decisions
> about the biochemical
> results in conjunction with clinical and
> radiological findings.
> 
> In my experience, there is no level of CA125 which
> definitely confirms a
> diagnosis of ovarian malignancy; as we all know,
> levels are very high in any
> condition with ascites and if there is any tumour in
> the region of the ovary
> (indeed, on one occasion I know that a patient with
> a
> CA125>2000 was assumed to have Ca ovary and
> treatment for this was
> commenced, before it was realised that she had
> lymphoma affecting the region
> of the ovary).
> 
> We, as clinical biochemists, have a responsibility
> to ensure that we provide
> appropriate interpretation of results - in this case
> I suspect that this
> test would have crept through the requesting net in
> my own laboratory but I
> would (I hope!) have added a comment that that CA125
> is a non-specific
> marker and that the result was not diagnostic of Ca
> Ovary and that tumour
> markers should not be used for diagnosis of
> malignancy.
> 
> 
> Cathryn Corns
> Consultant Biochemist
> Clinical Director of Pathology
> 01702 435555  ext 4058
> 
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf
> Of Douglas Thompson
> Sent: 02 June 2005 10:14
> To: [log in to unmask]
> Subject: Re: Non-specific CA125
> 
> Sorry Elizabeth cannot agree with this.  There is
> little evidence that
> tumour markers have a role in the diagnosis of
> malignancy and would
> certainly not be indicated in AE.  Every day I see
> inappropriate requests
> for tumour markers where a panel of all the markers
> they can think of is
> requested for ? malignancy. Quite often one will be
> slightly raised and then
> this will be repeated ad infinitum.  We have to make
> the best use of limited
> resource using available evidence - Mike is right.
> 
> Douglas Thompson
> 
> Dr D Thompson
> Principal Biochemist
> Clinical Biochemistry and Immunology
> The General Infirmary
> Leeds  LS1 3EX
> Tel 0113 3926503
> 
> Please visit our web-site at
> www.leedsteachinghospitals.com
> 
> >>> Elizabeth Mac Namara
> <[log in to unmask]> 06/01/05 10:27
> >>> pm >>>
> I have a real problem with this question. I do not
> think it appropriate to
> say that CA-125 was done for the usual 'crap
> reasons' . It is usual for
> female patients who come in to a hospital with
> hypercalcaemia and are 80 to
> be investigated for an underlying malignancy. It is
> appropriate to look at
> several tumour markers, if there are no localising
> signs. Are you saying
> that CTs, abdominal scans etc be done first and only
> if a tumour is seen to
> do tumour markers? I am amazed at this unnecessary,
> and I feel wrong,
> criticism of the ER staff.
> 
> 
> Elizabeth Mac Namara
> 
> At 11:04 AM 01/06/05, Hallworth Mike (RLZ) wrote:
> 
> >Hi all
> >
> >We have a 83 year old lady admitted in February
> with increasing
> >confusion and decreasing mobility. She was
> hypercalcaemic (Ca 3.09, PTH
> 
> >8.3) and dehydrated (urea 23.1, creat 242) with a
> raised CRP (227).
> >This was treated with pamidronate and iv fluid and
> rapidly normalised. 
> >USS abdomen showed signs consistent with chronic
> urinary retention.
> >
> >Her CA125 on admission (done for usual crap
> reasons) was 8017 U/ml. CT
> >pelvis shows no evidence of gynae malignancy, but
> marked soft tissue 
> >thickening at the ano-rectal junction, "highly
> suggestive of local 
> >malignancy". This was being followed up by flexible
> sigmoidoscopy, 
> >which was attempted in early April but was
> unsuccessful due to poor 
> >bowel prep and is waiting to be repeated. There has
> been no other
> treatment for this.
> >
> >In the meantime, the CA125 has been repeated at
> 1281 on 14 March and 56
> 
> >on
> >21 April - so falling quite nicely with a half life
> of 7-8 days, which
> >makes it all look as if it was a non-specific
> increase secondary to 
> >infection/inflammation, also reflected in the CRP.
> Those are fairly 
> >common, but isn't >8000 very high for that?
> >
> >Thoughts or experience greatly appreciated.
> >
> >Thanks
> >
> >Mike
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Dr. M A Al-Jubouri
Consultant Chemical Pathologist


	
	
		
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