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Teachable Moment
May 11, 2020

The Dangers of Using Tumor Markers to Evaluate Nonspecific Symptoms: A Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, University of Colorado, Aurora
JAMA Intern Med. Published online May 11, 2020. doi:10.1001/jamainternmed.2020.1293

A woman in her 50s with idiopathic dilated cardiomyopathy (ejection fraction, 15%-20%), quiescent celiac disease, chronic diarrhea due to active lymphocytic colitis, and treated hypothyroidism presented with malaise and anorexia of several weeks’ duration. She did not have abdominal pain, nausea, vomiting, weight loss, or fever. Given her age and nonspecific symptoms, the clinician was concerned for possible cancer. As part of her initial workup, levels of carbohydrate antigen 19-9, carcinoembryonic antigen, and cancer antigen (CA)-125 were measured. The CA-125 level was elevated, at 210 U/mL (normal, ≤35 U/mL). The patient was referred to a gynecologist owing to concern for ovarian cancer. Pelvic ultrasonography and abdominal computed tomography did not reveal evidence of ovarian cancer.

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