title: Clinical utility of determining tumor markers in patients with signs and symptoms of cancer.
abstract: BACKGROUND
  Diagnosing patients with signs or symptoms suggestive of cancer is difficult. Serum tumor markers (TM) may be useful, but it is known that a range of pathologies other than cancer can increase their concentrations and so TM data must be interpreted with caution. The aim of this study is to determine the diagnostic accuracy of TMs in patients with signs or symptoms of cancer.
  
  
  METHODS
  We prospectively studied 234 patients seen at rapid diagnostic units who presented signs or symptoms suggestive of cancer. Ninety patients had wasting syndrome, 74 had pulmonary symptoms and 70 other presentations. CYFRA21-1, CEA, CA19-9, total bilirubin and creatinine were determined. The final diagnosis was obtained after 6 months' follow-up. Patients were classified according to the absence (group A) or presence (group B) of abnormal bilirubin or creatinine.
  
  
  RESULTS
  Of the 234 patients studied, 103 (44.0%) had tumors diagnosed. Cut-off points for each TM were calculated for a specificity of 100%. For the total group, the values were CYFRA21-1, 15 μg/L, CEA, 43.8 μg/L and CA19-9, 7428 KU/L, with an overall sensitivity of 46.6%. For group A (n=142), the following cut-off points were established: CYFRA21-1, 7.8 μg/L, CEA, 13.8 μg/L and CA19-9, 101 KU/L, obtaining a sensitivity of 68.6%. For group B (n=92), the values were the same as for the whole group, and a sensitivity of 42.4% was achieved.
  
  
  CONCLUSIONS
  We conclude that TMs can aid diagnosis in these patients with signs or symptoms suggestive of cancer. Their sensitivity can be improved by using different cut-off points in the presence and absence of renal and hepatic dysfunction.
authors.forename: Jaume
authors.initials: J
authors.lastname: Trapé
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
authors.forename: Fina
authors.initials: F
authors.lastname: Franquesa
authors.forename: Josep M
authors.initials: JM
authors.lastname: Ordeig
authors.forename: Josep M
authors.initials: JM
authors.lastname: Soler-Bel
authors.forename: Eva
authors.initials: E
authors.lastname: Bustamante
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez
authors.forename: Jordi
authors.initials: J
authors.lastname: Aligué
authors.forename: Jesús
authors.initials: J
authors.lastname: Montesinos
authors.forename: Anna
authors.initials: A
authors.lastname: Arnau
authors.forename: Roser
authors.initials: R
authors.lastname: Ordeig-Villanueva
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D053539:Keratin-19 / Q000097:blood; D008175:Lung Neoplasms / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies
chemical_list: D000951:Antigens, Neoplasm; D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D053539:Keratin-19; C102012:antigen CYFRA21.1; C578959:carbohydrate antigen 199, human; D003404:Creatinine; D001663:Bilirubin