Last updated: Thursday, 18, November, 2010
Key InformationAppropriate Tests

As appropriate - tumour biopsy, including FNAB fresh tissue may be required - consult pathologist. Cytological examination of associated fluids (eg, effusions); tumour markers (serum). Generally, tumour markers should not be used as screening tests for the presence of malignant disease in asymptomatic individuals. They are often unreliable for the detection of malignancy: a negative result does not exclude malignancy, a positive result does not establish the diagnosis of malignancy. If the patient has proven carcinoma, and tumour markers are positive, the marker(s) can be used to monitor disease progress. Chromosome analysis (cytogenetics oncology) and molecular genetics testing of tumour tissue are used as prognostic indicators in an increasing number of tumours.(Consult pathologist) A history suggestive of familial or genetic cancer requires follow up. See also entries for specific tumours/sites and complications of advanced/metastatic cander.

Specific tumor sites

Breast carcinoma

Tumour markers CA 15.3, MSA, CA 549 are of only limited use in monitoring progression of disease; carcinoembryonic antigen is occasionally useful for monitoring disease progression.

Colonic carcinoma

Carcinoembryonic antigen, CA 19.9 may be useful to monitor disease progression.

Molecular genetics (APC gene) with investigation of family members if the disorder is familial.

Ovarian carcinoma

CA 125 is of value in monitoring progression of disease with serous carcinoma. See also Ovarian mass

Pancreatic carcinoma

CA 19.9 is of value in monitoring disease progression. See also Pancreatic neoplasm

Prostatic carcinoma

PSA See also Prostatic enlargement



Hepatocellular carcinoma

Alpha fetoprotein - serum.

Neural crest tumours, especially 

Neurone specific enolase.
Complications of Advanced/metastatic cancer

Anaemia, due to:

FBC, blood film.
  • Cytotoxic drugs/irradiation
  • Bone marrow infiltration
See Leucoerythroblastic anaemia.

Bleeding, due to:

FBC, blood film.
  • Cytotoxic drugs/irradiation
  • Bone marrow infiltration
See Leucoerythroblastic anaemia.
Malnutrition, biliary obstruction: PT.
  • Liver metastases
Failure of coagulation factor synthesis: PT, APTT, thrombin time, fibrinogen; LFT.
Bone metastasesCalcium.

Neutropenia, due to:

FBC, blood film. See Febrile neutropenia.
  • Cytotoxic drugs/irradiation
  • Bone marrow infiltration
See Leucoerythroblastic anaemia.




Bone fracture (pathological)




Ectopic ACTH syndrome

See Cushing's syndrome

Paraneoplastic syndromes, including

  • Polyneuropathy
See under Neuropathy.
  • Encephalomyelitis
Purkinje cell (HU) antibodies.
  • Cerebellar degeneration
Purkinje cell (YO) antibodies.