Rising Tumor Markers Do Not Necessarily Mean Treatment Has Failed
There is an ovarian cancer patient whom I have been treating for some time. Over the past six months or so, every time she was tested, her CA125 rose a little. To be honest, this was quite unnerving for me, because CA125 is a very sensitive tumor marker in ovarian cancer patients.
I almost wanted to give up treating this patient, but she herself insisted on not giving up, because she could clearly feel that her physical condition had been steadily improving while taking Chinese herbal medicine. More importantly, she did not have many better options. So I had to steel myself and continue treating her.
Recently the patient underwent a PET/CT at Peking Union Medical College Hospital. This scan showed that her condition had clearly improved compared with a year earlier: her liver metastases had markedly decreased, and the mediastinal and hilar lymph nodes that had appeared a year ago were no longer evident.
A continuously rising tumor marker is generally regarded as an early sign of tumor recurrence. However, many scholars also point out that during treatment, a rise in tumor markers may also indicate that the treatment is effective against the tumor, accompanied by a transient elevation of tumor markers.
For example, the Chinese Expert Consensus on the Diagnosis and Treatment of Advanced Breast Cancer, edited by Xu Binghe and others, points out that in patients without measurable metastatic lesions, an isolated rise in tumor markers may also be a sign that treatment is effective; therefore, a mere rise in tumor markers cannot be used as the basis for changing the treatment plan.
For advanced cancer patients, tumor markers are only one reference value during treatment. Many patients become terrified when their tumor markers rise, and this understanding needs to be adjusted.
An isolated tumor marker result cannot serve as evidence of tumor recurrence or disease progression; it must be combined with imaging studies before a correct judgment can be made.
Generally speaking, patients on chemotherapy should have their treatment response evaluated with imaging every 2–3 cycles; cancer patients taking Chinese herbal medicine or endocrine therapy should have an imaging evaluation every 2–3 months, which is a reasonable interval.
Of course, for some patients whose disease progresses slowly and who do not feel seriously unwell, imaging may not need to be done so frequently. The frequency can be adjusted according to the patient’s own wishes and by observing their physical condition.
A sustained decline in tumor markers can be taken as a reference that treatment is effective, but a sustained rise in tumor markers does not necessarily mean treatment has failed. This view may sound unbelievable, but in clinical practice such situations do indeed occur. I hope our patients and their families will not be overly frightened when tumor markers rise. If you are worried about a rising tumor marker, you can have periodic imaging examinations to judge the progression of the disease more accurately.