Share on Facebook
Share on Twitter
Share on LinkedIn
Share by Email
Print
In addition to serum tumor markers, patients often wonder why a physician might not order a plethora of follow-up scans so they can be deemed cancer-free. It is important to explain to patients that a billion cancer cells have to collect in one particular spot to be detected, even on a highly sensitive detection scan such as a CT. Millions of cells could be anywhere and go undetected.
A recent randomized trial evaluated lymphoma outcomes when the patient was followed up with regularly scheduled imaging studies versus obtaining similar radiographs only when patients had symptoms of recurrent cancer. Just as in the case of ovarian cancer and the CA-125, the outcome was the same. Too often physicians are judged more by their use of high tech scans than by their astute clinical skills. Too often the request for a PET/CT is the result of advice from a conversation over the fence with a patient’s neighbor than with their oncologist. More recently the choice has been taken out of the hands of the physician and the patient, as insurance companies and the like have refused payment based on this very issue. Patients expect their oncologist to battle their case, but the fact is we often lack the ammunition.4
This is not to say that in the future, with more research, very specific proteins to very specific tumors may result in early detection, but that accomplishment has not been attained in today’s oncology practice. Despite these arguments, and often after giving my long-time devoted patient this extensive explanation about tumor markers, they look at me, and say, “That’s all fine. Are you going to order my tumor markers now?” My jaw drops, and I order the tumor markers.
Donald Fleming is an oncologist/hematologist at the Cancer Care Center, Davis Medical Center, Elkins, West Virginia.
REFERENCES
1. Rustin GJ. Follow-up with CA125 after primary therapy of advanced ovarian cancer has major implications for treatment outcome and trial performances and should not be routinely performed. Ann Oncol. 2011;22(suppl8):viii45-viii48.
2. Bünger S, Laubert T, Roblick UJ, Habermann JK. Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview. J Cancer Res Clin Oncol. 2011;137(3):375-389
3. Jemal A Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–249.
4. Thompson CA, Ghesquieres H, Maurer MJ, et al. Utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma. J Clin Oncol. 2014;32(31):3506-3512.
