With the improvement of people’s living conditions, more and more friends pay more and more attention to their health problems, and annual check-ups have become a routine program. In the check-up report, the most frightening thing is the rising arrow behind the tumor marker value, many friends will suddenly have a huge panic after seeing the result, do I have cancer? Is there still a possibility of treatment? Do I need to be operated immediately? How long can I live? In fact, the elevation of tumor markers does not necessarily mean cancer, nor is it a simple verdict of life and death. Below, let’s unveil the mysterious veil of tumor markers. 1.What are tumor markers? Tumor marker refers to the substances present in malignant tumor cells, or produced by their abnormalities, or produced by various kinds of stimulation of the human body to the tumor, which can reflect the existence of the tumor in the human body to a certain extent, and with the change of the tumor load and the treatment, its fluctuation in the body can be obvious. Tumor markers are present in the patient’s tissues, body fluids and excretions, and can be detected by immunological, biological and chemical methods, as well as in the normal human body. Common tumor markers include AFP, CEA, CA-199, CA72-4, CYFRA, PSA, CA-125, CA-153 and so on. 2. Clinical significance of tumor markers 1) Early discovery of tumors: when normal cell cancer starts to appear in the body, patients often do not have any symptoms, and CT, MRI, X-ray and other inspections have a certain maximum resolution, and early tumors are often unable to be shown on imaging, so at this time, tumor marker test can be used as a kind of screening means to discover the existence of tumors in the body at an early stage. 2) Tumor diagnosis and differential diagnosis: each tumor marker has one or several tumors it represents, when these tumors exist in the body, their corresponding tumor markers have a greater possibility of abnormal increase, thus providing reference and basis for clinical judgment. For example, the persistently high level of alpha-fetoprotein AFP is most common in primary liver cancer and non-spermatogonial testicular tumors; the abnormally high level of carcinoembryonic antigen CEA is most common in colon cancer, and if metastasis occurs in colon cancer, the elevation of CEA will be more obvious, and CEA positivity can be detected in other digestive tract tumors as well, such as pancreatic cancer, lung cancer, and gastric cancer etc.; Glycoside antigen 19-9, CA-199, and the level of CA19-9 has been significantly increased in the blood serum of some patients with pancreatic cancer. CA19-9 level of some pancreatic cancer patients is obviously increased, and CA19-9 level of liver and biliary tract cancer, gastric cancer and colorectal cancer will also be increased. 3) Monitoring the efficacy of surgery, chemotherapy and radiotherapy for tumor patients: when there is a large tumor load in the body, the tumor markers are often at a high level; after the patients undergo anti-tumor treatments, such as surgery, radiotherapy and chemotherapy, the tumor load in the body will obviously decrease, and the level of tumor markers will also decrease, so as to judge the efficacy of the treatments. (4) Monitoring index of tumor recurrence: after surgical resection of tumor, regular review is often needed, and the most simple and important index in the review is tumor marker. If tumor recurrence and metastasis occurs, with the sharp increase of tumor load, the level of tumor marker in the body will also rise significantly. Elevated tumor markers are not equal to cancer In the most ideal situation, once the tumor markers are elevated, it should be possible to diagnose cancer, i.e. the sensitivity should be 100%; if it is normal, it can be clearly excluded cancer, i.e. the specificity is 100%. However, in clinical practice, no tumor marker can achieve 100% sensitivity and specificity, that is to say, an elevated tumor marker does not necessarily mean that one is suffering from cancer, while a normal tumor marker does not necessarily indicate that one is not suffering from cancer. First of all, not all malignant tumors will cause elevated tumor markers, for example, CA72-4 and CA-242 will be significantly elevated in the majority of gastric cancer patients, but these two indexes may be normal in gastric hepatoid adenocarcinoma patients. Secondly, although most of the tumor markers are produced by malignant tumor cells, a certain level of tumor markers can also exist in normal body, and some benign diseases, such as inflammation, tumor markers are also likely to be elevated, for example, AFP may be obviously elevated in patients with hepatitis B, and when peritoneal tuberculosis exists, CA-125 may be abnormally elevated. These cases do not imply the development of primary liver cancer or ovarian cancer. In addition, I once encountered a patient in the clinic, the obvious elevation of AFP caused great panic in the patient’s family, and after a few rounds of troubles, it was found that he did not suffer from liver cancer, so what exactly caused the abnormal AFP? It turned out that the patient’s blood was not immediately sent for testing after extraction, but delayed for 2 days, resulting in blood concentration, making a big mess, so the preservation of specimen samples also has a great impact on the test results. It is worth noting that negative tumor markers do not completely exclude the possibility of developing a tumor. For example, in patients with primary liver cancer, the positive rate of AFP, the corresponding specific tumor marker, is only 70%-90%, which means that 10%-30% of patients with primary liver cancer have normal AFP or only mildly elevated AFP. Therefore, normal tumor marker can only be used as a reference, and comprehensive examination is still needed to make a clear diagnosis. If you judge that there is no problem just by the results of tumor marker test, it will often cause more serious problems. 4. How to interpret tumor markers correctly At present, there are many tumor markers applicable in the clinic, and the sensitivity or specificity of using them individually is often low, which is difficult to be used as an effective reference basis. If a variety of tumor markers can be used in combination, the sensitivity and specificity of diagnosis can be improved, for example, in the screening of gastric cancer, CEA, CA72-4, CA242, CA-199 are often combined together and called CA-125, CA-125 and CA-125, which are called CEA, CA72-4 and CA242, When screening for gastric cancer, CEA, CA72-4, CA242, CA-199, CA-125 are often combined together and called gastric cancer tumor marker combination, through which the combination can prove the existence of the tumor and the size of the load in various aspects, and also can make differential diagnosis with some easily confused tumors, thus receiving miraculous results. Tumor markers are convenient and easy to use, and can be examined by drawing blood, which is painful and less costly for patients. However, it is only a reference for cancer screening, and cannot be used as a gold standard for cancer diagnosis, which needs to be considered in combination with other means, such as clinical symptoms and imaging examinations. The most important basis for cancer diagnosis is still pathology examination, and only when there is clear pathological evidence can the diagnosis be finalized. Each person has certain individual differences, and the progression of the disease is different, so the results of tumor markers should be interpreted in conjunction with clinical practice in order to draw a true conclusion. We should not generalize, nor should we be negligent. Finally, let me summarize by borrowing the famous words of Liu Bei who admonished Ah Dou: “Don’t do evil for the sake of evil, and don’t fail to do good for the sake of good”.