People with long term conditions

Question 1

Tumour markers

Answer 1

✓ CEA is the most commonly used tumour marker used in colorectal cancer but it is not specific or sensitive enough to make a diagnosis of cancer. It is often used post-operatively in colon cancer.
✓ It can be elevated in other benign conditions including liver disease and Inflammatory Bowel Disease.
✓ CA125 is used in ovarian cancer. CA 19-9 is used in gastric, hepatobiliary and pancreatic cancer.
✓ AFP is used in teratoma and hepatocellular carcinoma.
✓ Calcitonin is used in medullary thyroid carcinoma.

Question 2

Clubbing

Answer 2

✓ Respiratory causes of clubbing include lung carcinoma, Fibrosing alveolitis, Bronchiectasis, empyema, lung abscess, Cystic Fibrosis and pleural Mesothelioma.
✓ Hypertrophic osteoarthropathy includes finger clubbing, periostitis and arthritis and these symptoms are commonly associated with squamous cell carcinoma and adenocarcinoma carcinoma of the lung.
✓ Alpha-1 antitrypsin deficiency does not cause clubbing but recurrent ulcerative necrotizing panniculitis can be a typical cutaneous feature.
✓ COPD does not cause clubbing either and hence any clubbing noted in patients should prompt consideration of an alternative or co-existing diagnosis such as Bronchiectasis or lung cancer.
✓ Cyanotic congenital heart disease and Infective Endocarditis are cardiovascular causes of clubbing.

Question 3

2-week wait referrals

Answer 3

> 45 with visible haematuria (?Renal Ca)
Postmenoausal bleeding (?Endometrial Ca)
40 with dysphagia
40 with weight loss PLUS abdominal pain/