To all the informed people out there - I sent this out a couple of weeks
ago but not one reply or comment was seen.
Did it get lost in the ether, or is everyone away on holiday?
Suggestions would be appreciated.
The new NICE guidelines on malignancy of unknown origin recommend
measuring CA125 in patients with ascites:
1.2.1.1 includes
Measure
* cancer antigen 125 (CA125) in women with peritoneal malignancy or
ascites (see recommendation 1.2.2.1)
However, as CA-125 is increased in ascites and pleural effusion (and
pericardial effusion) of any cause this is surely going to mislead
clinicians. I've seen it over 1000 in patients with ascites of liver
failure (yes, we measured it just to prove the point!)
Does anyone know where this recommendation came from? Has anyone got
references to any good studies showing that this is useful?
Tumour markers
1.2 .2.1 Do not measure tumour markers during diagnosis except for:
* AFP and hCG in patients with presentations compatible with
germ-cell tumours (particularly those with mediastinal and/or
retroperitoneal masses and in young men).
* AFP in patients with presentations compatible with hepatocellular
cancer.
* PSA in men with presentations compatible with prostate cancer.
* CA125 in women with presentations compatible with ovarian cancer
(including those with inguinal node, chest, pleural, peritoneal or
retroperitoneal presentations). Carefully interpret the results because
of limited test specificity.
At least this guideline suggests we shouldn't be doing CEA as a
diagnostic test - well we knew that anyway even if the clinicians
didn't. No doubt they'll be wanting CEA despite the recommendation.
Michael
Dr. C . M. Colley
Consultant Chemical Pathologist
Great Western Hospital
Swindon SN3 6BB
Great Western Hospitals NHS Foundation Trust Great Western Hospital Marlborough Road Swindon
SN3 6BB
Tel 01793 60 40 20
http://www.gwh.nhs.uk
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