Cancer Screening Malaysia: Cancer Markers, Who Needs Testing & When

Cancer markers (also called tumour markers) are substances produced by cancer cells or by normal cells in response to cancer. They are measured in the blood. Here is what each major marker indicates: AFP (Alpha-Fetoprotein): - Primary use: liver cancer (hepatocellular carcinoma) screening and monitoring - Also elevated in: testicular cancer, ovarian germ cell tumours, cirrhosis of the liver, and normal pregnancy - Recommended for: individuals with hepatitis B or C, cirrhosis, or family history of liver cancer. Consider annually for hepatitis B carriers. - Normal: below 10 ng/mL (varies by laboratory) CEA (Carcinoembryonic Antigen): - Primary use: monitoring colorectal cancer after treatment; raised levels can indicate recurrence - Also useful in: lung, breast, stomach, and pancreatic cancers - Important limitation: also elevated in smoking, COPD, inflammatory bowel disease, and liver disease — not specific to cancer - Not recommended as a sole screening tool in asymptomatic people, but useful when combined with other tests or as baseline in those over 50 PSA (Prostate-Specific Antigen): - Primary use: prostate cancer detection and monitoring - The most important cancer marker for Malaysian men over 50 - PSA is produced by the prostate gland — both normal and cancerous. Elevated PSA (above 4.0 ng/mL) requires further evaluation, but can also be raised by benign prostatic hyperplasia (BPH), prostatitis, and urinary tract infections - Recommended for: men over 50 for discussion of PSA screening; men over 40 with family history of prostate cancer; men of African descent over 40 CA125 (Cancer Antigen 125): - Primary use: ovarian cancer detection and monitoring - The most important cancer marker for Malaysian women at high risk - Limitation: CA125 is also elevated in endometriosis, fibroids, pelvic inflammatory disease, and peritonitis — reducing specificity - Recommended for: women over 40, women with family history of ovarian or breast cancer (BRCA gene mutations) CA19-9 (Cancer Antigen 19-9): - Primary use: pancreatic cancer and biliary tract cancer detection - Also elevated in: cholangitis, gallstones, pancreatitis, and liver disease - Recommended for: individuals with unexplained upper abdominal pain, weight loss, or jaundice; those with chronic pancreatitis CA15-3 and CA27.29: - Primary use: breast cancer monitoring after diagnosis - Less useful for primary screening as they can be normal in early breast cancer HER2, ER, PR receptors: not blood tests but tissue tests done on breast cancer biopsy samples to guide treatment decisions.

Receiving an elevated cancer marker result can be alarming — but it is critical to understand what it does and does not mean before panicking. An elevated cancer marker is not a diagnosis of cancer. It means further investigation is warranted. Here are the key principles: 1. Many non-cancerous conditions raise cancer markers: - AFP elevated in: hepatitis, cirrhosis, pregnancy - PSA elevated in: benign enlarged prostate (very common in men over 50), prostatitis, urinary tract infection - CA125 elevated in: endometriosis, fibroids, pelvic inflammatory disease, pregnancy, menstruation - CEA elevated in: smoking, inflammatory bowel disease, COPD, liver disease 2. Cancer markers can be falsely normal: - Early cancers may not produce detectable levels of markers - Some aggressive cancers produce little marker substance - This is why markers are not ideal standalone screening tools 3. Trend matters more than a single value: - A PSA that has been stable at 5.0 ng/mL for 5 years is less concerning than a PSA that has risen from 2.0 to 6.0 in one year - PSA velocity (rate of rise) and doubling time are clinically important 4. What happens next with an elevated result: - PSA elevated: prostate ultrasound and possibly biopsy; urology referral - AFP elevated: liver ultrasound; hepatology or gastroenterology referral - CA125 elevated: pelvic ultrasound; gynaecology referral - CEA elevated: colonoscopy referral; CT scan if indicated At Klinik Muhibbah, our doctors explain all results in context and guide you on appropriate next steps — including referrals to specialists when needed.