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Diagnostic Evaluations

Laboratory tests

What are laboratory tests?

Doctor may use a variety of laboratory tests if cancer is suspected. In conducting lab tests for cancer, samples of blood, urine, other bodily fluids or tissue are examined for abnormal cells or tumor markers that may determine whether a person has the disease or a precancerous condition. Lab tests also may be used to screen high-risk patients, pinpoint the stage of cancer, identify treatment options and evaluate whether the cancer is responding to treatment. Lab tests may also be used to determine whether a patient has a cancer recurrence—a disease that has returned to its original location—or whether a new cancer has developed. 

Examples of the types of laboratory tests we use include:

CTC test

Cellsearch™ circulating tumor cell (CTC) tests may be used to monitor metastatic breast, colorectal and prostate cancers. This diagnostic test helps capture, identify and count circulating tumor cells in a blood sample. CTCs are cancer cells that detach from solid tumors and enter the bloodstream. The blood test may be performed prior to the start of therapy or during the course of treatment.

Complete blood count test

A complete blood count (CBC) test measures the number of blood cells circulating in the bloodstream. Specifically, it measures a blood sample for the level of red blood cells, which carry oxygen throughout the body; white blood cells, which fight infection; and platelets, which help with blood clotting. The test also measures hemoglobin, a protein in red blood cells that carries oxygen, and hematocrit, the ratio of red blood cells to plasma.

A CBC may be used to detect a variety of conditions, including leukemia, anemia and infection. Also, because some cancer treatments may temporarily lower blood counts, oncologists often use CBC tests throughout treatment to closely monitor a patient’s blood counts.

Flow cytometry

This test is used to diagnose and classify certain cancers, such as leukemia and lymphoma, and to evaluate the risk of recurrence. Flow cytometry also may be used as part of the stem cell transplantation process.

Flow cytometry measures the properties of cells in a sample of bone marrow, lymph nodes or blood. The sample is first treated with special antibodies and passed in front of a laser beam. If the antibodies attach to the cells, the cells give off light. The presence of certain substances, or antigens, on the surface of cells may help identify the cell type.

Flow cytometry may also be used to measure the amount of DNA in cancer cells. In this case, the cells are treated with special light-sensitive dyes that react with DNA. For patients with breast, prostate or bladder cancer, an abnormal amount of DNA may indicate a recurrence.

Mammaprint + Blueprint® test

The Mammaprint® 70-Gene Breast Cancer Recurrence Assay may be used to determine the risk that a patient’s cancer will return. A high-risk score means the cancer has a three-in-10 chance of returning. A low-risk result puts the chances at one in 10. Neither result is a guarantee that the malignancy will or will not come back, but the assessment may be used to guide treatment decisions.

The Blueprint® 80-Gene Molecular Subtyping Assay examines which of the tumor’s mutations are dictating the cancer’s behavior. When used with the Mammaprint assay, Blueprint may narrowly define each tumor into a subtype classification, which also may help guide treatment decisions.

Oncotype DX® test

The Oncotype DX lab test is used to determine whether chemotherapy is likely to benefit patients with early-stage breast cancer. It also helps evaluate the likelihood of disease recurrence.

This diagnostic test is often performed on a small amount of tissue removed during breast cancer surgery and then examined at a molecular level. The Oncotype DX test provides specific information about the disease, which may help guide treatment decisions.


What are tumor markers?

Tumor markers are substances in the body that are produced in much higher quantities when cancer or certain benign conditions are present. The substances may be found in the blood, urine, stool or tumor tissue. Most of these substances are proteins, but sometimes gene expression patterns and DNA changes are used as tumor markers, as well.

Because an elevated tumor marker doesn’t necessarily indicate cancer, tumor markers cannot be used alone to diagnose cancer. Generally, tumor marker measurements are used in combination with other tests, such as biopsies.

Tumor marker tests used to diagnose cancer include:

CA-125 test

A CA-125 test measures the amount of the cancer antigen 125 (CA-125) in a person’s blood. CA-125 is a protein that is a biomarker or tumor marker. The protein is found in higher concentration in cancer cells, particularly ovarian cancer cells.

Cancer types that may cause higher-than-normal levels of CA-125 include:

Cancer that has spread to the peritoneum, the abdomen’s lining, may also cause higher-than-normal levels of CA-125.

It’s important to note that conditions other than cancer may cause higher levels of CA-125, including uterine fibroids, endometriosis. lupus. liver disease and pancreatitis

Prostate-specific antigen test

A prostate-specific antigen (PSA) test measures the level of PSA in the blood. The prostate gland produces PSA, a protein that at an elevated level may be a sign of prostate cancer. A high PSA reading also may indicate noncancerous conditions, such as inflammation of the prostate (prostatitis) and enlargement of the prostate (benign prostatic hyperplasia).

Men who have symptoms associated with prostate cancer may have a PSA test along with a digital rectal exam (DRE).  According to the National Cancer Institute, research shows that men with prostate cancer may have a low PSA level, while men without prostate cancer may have a high level. One in four men with an elevated PSA level actually has prostate cancer. However, an increase in PSA level over time may indicate prostate cancer. That’s why some men with a high PSA level may be monitored under active surveillance, which involves PSA testing at regular intervals.

Other tumor markers doctors look for when diagnosing and treating cancer include:

Marker Associated cancers Test Comments
Alpha-fetoprotein (AFP) Liver cancer Blood test Tests may help diagnose and stage cancer, determine treatment options and measure response to treatment.
Beta-2-microglobulin (B2M) Multiple myeloma, chronic lymphocytic leukemia, and some lymphomas Blood, urine, spinal fluid Tests may help determine response to treatment and prognosis.
Beta-human chorionic gonadotropin (Beta-hCG) Choriocarcinoma and germ cell tumors Urine or blood Tests may help diagnose and stage cancer, determine treatment options and measure response to treatment.
CA15-3/CA27.29 Breast cancer Blood Tests may help diagnose cancer recurrence and measure response to treatment.
CA19-9 Pancreatic cancer, gallbladder cancer, bile duct cancer, and gastric cancer Blood Tests may help measure response to treatment.
Calcitonin Thyroid cancer Blood Tests may help diagnose cancer and measure response to treatment.
Carcinoembryonic antigen (CEA) Colorectal cancer Blood Tests may help diagnose cancer recurrence and measure treatment response.
Chromogranin A (CgA) Neuroendocrine tumors Blood Tests may help diagnose cancer recurrence and measure response to treatment.
HE4 Ovarian cancer Blood Tests may help determine treatment options, monitor for recurrence and measure response to treatment.
Immunoglobulins Multiple myeloma and non-Hodgkin lymphoma Blood and urine Tests may help diagnose disease, monitor recurrence and measure response to treatment.
Neuron-specific enolase (NSE) Lung cancer Blood Tests may help diagnose disease and measure response to treatment.
Nuclear matrix protein 22 Bladder cancer Urine Tests may help measure response to treatment.
Thyroglobulin Thyroid cancer Blood Tests may help monitor response to treatment and diagnose recurrence.