End of Life Care

1. Tumour markers: 

Most are lousy for screening, using for risk stratification and monitor response. frequent false positive with infection, pregnancy, smoking, PPIs etc. 

1. Germ Cell Tumours

• AFP (α-fetoprotein): ↑ in non-seminomatous testicular cancer, hepatocellular carcinoma. Not raised in seminoma.

• β-hCG: Testicular cancer (especially choriocarcinoma), gestational trophoblastic disease.

• LDH: Non-specific, reflects tumour burden.

2. Gastrointestinal Cancers

• CEA (Carcinoembryonic Antigen): Colorectal cancer (not for screening; used for recurrence/monitoring).

• CA 19-9: Pancreatic cancer, cholangiocarcinoma (can be raised in benign biliary obstruction).

• AFP: Hepatocellular carcinoma (also germ cell tumours, as above).

3. Breast & Gynaecological Cancers

• CA 15-3 / CA 27-29: Breast cancer (monitoring, not diagnostic).

• CA-125: Ovarian epithelial cancers (used in diagnosis, follow-up, recurrence).

• β-hCG & AFP: Germ cell ovarian tumours.

4. Urologic Cancers

• PSA (Prostate Specific Antigen): Prostate cancer (screening, staging, monitoring; false positives with BPH, prostatitis).

• Prostatic Acid Phosphatase (PAP): Rarely used now; historical marker.

5. Endocrine & Neuroendocrine Tumours

• Calcitonin: Medullary thyroid carcinoma.

• Thyroglobulin: Papillary/follicular thyroid carcinoma (monitoring recurrence).

• Chromogranin A: Neuroendocrine tumours (carcinoid, pheochromocytoma).

• ACTH, Cortisol: Paraneoplastic syndromes.

6. Others

• S-100, HMB-45, LDH: Melanoma.

• Bence Jones Proteins (urine), M protein (SPEP/UPEP): Multiple myeloma.

• β2-microglobulin: Lymphoma, myeloma, prognosis indicator.