Free Shipping on All Orders $75 Or More!

Your Trusted Brand for Over 35 Years

Health Protocols

Cancer Adjuvant Therapy

The Value of Blood Testing in Monitoring Cancer

Blood tests can be helpful in monitoring the effectiveness of cancer therapy when used along with imaging and careful examination.

Tumor Markers

Some cancers produce molecules called tumor markers that can be detected in the blood and used to assess cancer activity. Tumor marker tests are not specific, however. This means that, in some cases, non-cancerous sources of a marker can increase the concentration of the marker and produce a false-positive result of cancer. Tumor marker tests should always be interpreted by a qualified healthcare provider.

Table 1. Types of cancer and tumor markers used for assessment

Type of Cancer

Tumor Marker

Breast cancer

Cancer antigen (CA) 27.29, CA15-3, carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125)

Bladder cancer

Bladder tumor antigen (BTA), NMP22 (urine tests); CA15-3 (blood test)

Colon, rectum, stomach, and cancers in some other organs

CEA, CA 19-9

Leukemia, lymphoma

Lactate dehydrogenase (LDH)

Liver cancer

Alpha fetoprotein (AFP)

Lung

Cytokeratin fragment 21-1

Ovarian cancer

CA-125, CEA, AFP

Prostate cancer

Prostate-specific antigen (PSA), prostatic acid phosphatase (PAP)

Pancreatic cancer

CA 19-9, CEA

Testicular cancer (and other germ cell tumors)

AFP, beta-human chorionic gonadotrophin (beta-HCG)

Thyroid cancer

Thyroglobulin, calcitonin (medullary form only)

Neuroendocrine tumors

Chromogranin A

(Vachani 2018)

Fasting Blood Glucose and Hemoglobin A1C

Hyperglycemia (high blood glucose level) and type 2 diabetes have been associated with worse outcomes in studies of people who have, or have had, various types of cancer (Ryu 2014; Storey 2012; Gallagher 2015; Healy 2015). In addition, hyperglycemia is associated with lower immune function (Jafar 2016; Turina 2005) and may increase the risk of infections in patients with cancer (Storey 2012). Both cancer and cancer treatment frequently cause hyperglycemia; therefore, it is important to monitor glucose control using blood tests such as fasting blood glucose and hemoglobin A1C (Sherwani 2016; Storey 2017; Gallo 2018). Although the normal range for fasting blood glucose is 70–100 mg/dL, and hemoglobin A1C is normal below 5.7% (NIH 2018c; NIH 2018d), some health experts recommend people without diabetes maintain a fasting glucose level of 70–85 mg/dL and a hemoglobin A1C below 5% for optimal health.

Lactate Dehydrogenase

Cancer cells have long been noted to metabolize glucose into energy differently from normal cells: normal cells mainly use a series of reactions called oxidative phosphorylation that requires oxygen and yields a high amount of energy per unit of glucose; cancer cells mainly use a less efficient pathway called glycolysis that does not require oxygen and produces lactate as an end product. This metabolic phenomenon, in which cancer cells depend on glycolysis even in the presence of oxygen, is known as aerobic glycolysis or the Warburg effect and results in high glucose demand and an increased production of lactate by cancer cells (Liberti 2016; Wulaningsih 2015).

Lactate dehydrogenase (LDH) is an enzyme that is used in the final step in glycolysis. LDH is overproduced in cancer cells and higher blood LDH levels are seen when cancer cells are active. High levels have been associated with worse outcomes in patients with several cancer types including lung, colorectal, prostate, gastroesophageal, gynecologic, kidney, and some breast cancers, as well as lymphoma and melanoma (Wulaningsih 2015; Liu R 2016; Li G 2016).

Normal values for the LDH test are 105–333 IU/L, but can vary slightly between laboratories. Importantly, several conditions other than cancer can cause LDH levels to rise (NIH 2018i), so high levels do not always mean that cancer cells are active in the body.

Alkaline Phosphatase

The enzyme alkaline phosphatase (ALP) is highly concentrated in cells of the liver and bones, two organs to which various cancer types often spread. An elevated ALP level in the context of cancer is not necessarily helpful in characterizing primary tumors, but suggests there may be metastases to the liver or the bones (Siddique 2012; D'Oronzo 2017). In a large meta-analysis of 19 studies including 3,268 patients with various solid tumors, higher ALP levels were significantly correlated with bone metastases (Du 2014). ALP may be useful in addition to the tumor marker cancer antigen 15-3 (CA15-3) for monitoring the recurrence of breast cancer (Keshaviah 2007). Elevated ALP levels are also considered a reliable indicator of bone metastasis in men with prostate cancer (Kamiya 2012). One study suggested that ALP levels of more than 90 U/L in men with newly diagnosed and untreated prostate cancer may indicate the cancer has spread to the bone, warranting a bone scan (Wymenga 2001). ALP is reported on routine metabolic panels as well as liver enzyme panels. If the ALP level is high, isoenzymes can be ordered to distinguish the source of the ALP (liver vs. bone) (Lowe 2017).

The normal range for ALP can vary between laboratories, but is generally 44–147 IU/L. ALP levels are normally higher in children during growth spurts and pregnant women, and can rise due to a number of conditions affecting bones or liver.

Vitamin D

Having a higher vitamin D level at or near the time of a cancer diagnosis results in an improved chance of survival (Li M 2014). One large meta-analysis concluded that higher vitamin D levels were correlated with a 26% lower risk of death and a 16% lower risk of disease progression in patients with cancer (Vaughan-Shaw 2017). In addition, vitamin D insufficiency and deficiency may have other negative health effects in patients with cancer, potentially increasing risks of infection, depression, pain, and low quality of life (Bjorkhem-Bergman 2016). It is therefore recommended that patients with cancer have their vitamin D status tested periodically.

Vitamin D status is assessed by measuring levels of 25-hydroxyvitamin D. 25-Hydroxyvitamin D levels of 30–50 ng/mL is generally considered healthy; levels of 20–29 ng/mL indicate insufficiency; and, levels below 20 ng/mL indicate deficiency (NIH 2018b; Holick 2011).

Other Laboratory Measures

Common complications and side effects of cancer and its treatment, such as fatigue, neuropathy, immune suppression, and liver or kidney damage, can linger for years. An annual complete blood count (CBC) and blood chemistry test to check for anemia, immune competence, liver and kidney function, and blood glucose and lipid regulation is recommended in everyone who has had a diagnosis of cancer (Bhatia 2017; Han 2017). Additional specific tests for nutrients that are commonly deficient after cancer treatment may include an iron panel and zinc, folate, and vitamin B12 levels (Gilreath 2014; Costello 2012).

Inflammatory Markers

Managing systemic inflammation may improve health and prognosis in people with cancer. Several blood tests can help gauge the level of systemic inflammation in patients with a history of cancer (Sylman 2018; Gu 2017):

  • C-Reactive Protein (CRP). CRP is a pro-inflammatory protein made in the liver that can be measured in the blood. High CRP levels have been associated with worse outcomes in a variety of cancers (Sylman 2018).

    While CRP production increases with inflammation, production of albumin, another protein made in the liver, often decreases. Tracking CRP and albumin at the same time may provide a better measure of systemic inflammation. A tool based on CRP and albumin levels, called the Glasgow Prognostic Score, has a proven track record in predicting outcomes in patients with a variety of cancers (Dolan 2017; Simmons 2017). The use of CRP to albumin ratio has also been shown to be useful for predicting prognosis in some patients with cancer. A meta-analysis of 25 studies assessing the use of the CRP to albumin ratio found that a higher ratio correlates with poorer outcomes for all cancers, except colorectal cancer (Xu 2017). Fish oil, containing omega-3 fatty acids, has been found to lower CRP levels and raise albumin levels, having a positive effect on the CRP to albumin ratio, in patients with gastrointestinal cancers (Mocellin 2013; Yu 2017; Mocellin 2016).
  • Platelets. Platelets are blood cells that are well known for their role in blood clotting. Platelets also influence the inflammatory response by releasing both pro- and anti-inflammatory chemicals and interacting with immune cells and microbes (Pankratz 2016; Thomas 2015; Kapur Semple 2016; Franco 2015). Platelets can also be recruited and activated by tumor cells and are involved in stimulating the growth and spread of cancers (Li N 2016; Meikle 2017). High blood levels of platelets have been associated with poorer outcomes in many cancers (Riedl 2014). A platelet count is reported as part of a CBC and is normally 150–400 × 109/L (NIH 2018f).
  • Fibrinogen. Fibrinogen is a protein that, along with platelets, is involved in blood clotting and inflammation and plays a role in cancer progression and metastasis (Zheng 2009; Davalos 2012; Palumbo 2000). A high fibrinogen level may be a marker for poor prognosis in patients with many different cancers (Perisanidis 2015). Fibrinogen levels are not checked as part of routine laboratory testing but can be easily added. A normal value is 200–400 mg/dL, or 2–4 grams/L.
;