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The Dangers of Using Tumor Markers to Evaluate Nonspecific SymptomsA Teachable Moment

Educational Objective
To emphasize the importance of using tumor marker testing only in the most appropriate clinical context to avoid patient anxiety and delayed diagnosis.
1 Credit CME

A woman in her 50s with idiopathic dilated cardiomyopathy (ejection fraction, 15%-20%), quiescent celiac disease, chronic diarrhea due to active lymphocytic colitis, and treated hypothyroidism presented with malaise and anorexia of several weeks’ duration. She did not have abdominal pain, nausea, vomiting, weight loss, or fever. Given her age and nonspecific symptoms, the clinician was concerned for possible cancer. As part of her initial workup, levels of carbohydrate antigen 19-9, carcinoembryonic antigen, and cancer antigen (CA)-125 were measured. The CA-125 level was elevated, at 210 U/mL (normal, ≤35 U/mL). The patient was referred to a gynecologist owing to concern for ovarian cancer. Pelvic ultrasonography and abdominal computed tomography did not reveal evidence of ovarian cancer.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Parisa Mortaji, MD, 13001 E 17th Pl, Aurora, CO 80045 (parisa.mortaji@cuanschutz.edu).

Published Online: May 11, 2020. doi:10.1001/jamainternmed.2020.1293

Conflict of Interest Disclosures: None reported.

References
1.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology, Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer: Version 3.2019-November 26, 2019. https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Accessed February 13, 2020.
2.
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3.
Ferraro  S , Mozzi  R , Panteghini  M .  Tumor marker ordering: do not lose control: a prospective clinical trial.   Am J Clin Pathol. 2015;144(4):649-658. doi:10.1309/AJCPNZAPJRB3T6KKPubMedGoogle ScholarCrossref
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Grossman  DC , Curry  SJ , Owens  DK ,  et al; US Preventive Services Task Force.  Screening for ovarian cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(6):588-594. doi:10.1001/jama.2017.21926PubMedGoogle ScholarCrossref
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Moss  EL , Hollingworth  J , Reynolds  TM .  The role of CA125 in clinical practice.   J Clin Pathol. 2005;58(3):308-312. doi:10.1136/jcp.2004.018077PubMedGoogle ScholarCrossref
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