Increased Serum CA-15.3 Levels in Patients with Megaloblastic Anemia due to Vitamin B₁₂ Deficiency

Abstract

Objectives: To estimate the usefulness of serum tumor markers’ monitoring, as predictors of gastric cancer in patients with pernicious anemia. Patients and Methods: We investigated serum levels of carcinoembryonic antigen (CEA), α-fetal protein, cancer antigen (CA)-19.9, CA-125 and CA-15.3 in 50 patients with pernicious anemia and in 24 healthy controls, matched for age and sex. In 38 patients, the evaluation was repeated 1–6 months after the correction of cobalamin deficiency. Results: All patients and controls had normal serum CEA and α-FP, and the levels of these markers as well as those of CA-125 and CA-19.9 did not differ between the two groups. All 50 patients, but only 2 controls exhibited increased serum CA-15.3, and the difference between the two groups was very significant (129.4 ± 84.9 vs. 19.8 ± 7.3 IU/ml, p < 0.001), while no difference between males and females was found. A thorough clinical examination of all patients, and mammographic study in 18 females did not reveal any finding suspicious of breast cancer. CA-15.3 levels were positively correlated with serum lactate dehydrogenase, and negatively with B₁₂ and hemoglobin, but they were substantially decreased after the correction of anemia, in all 38 patients tested, and in 33 of them they were restored to normal. After a median follow-up of 34 months, one patient developed a colon cancer, but none showed any sign suspicious of breast cancer. Conclusions: Serum CA-15.3 shows an aberrant increase in untreated patients with pernicious anemia, which is reversed after the correction of the anemia. The possible origin seems unrelated to mammary tissue, and may be released by the apoptosing bone marrow megaloblastic erythroblasts.

Utility of serum tumor markers as an aid in the differential diagnosis of patients with clinical suspicion of cancer and in patients with cancer of unknown primary site

“…No previous studies have evaluated the usefulness of tumor markers in the differential diagnosis of advanced tumors. Tumor markers are not specific for malignancy, and slightly elevated levels are found in some benign diseases, mainly liver or renal disorders, as our results confirm [28][29][30][31][32][33]. Most tumor markers show only slightly elevated levels in benign disease, and it is easy to discriminate between benign and malignant disorders using a different cutoff (CEA, CA 15.3, CA 72.4, AFP, or NSE).…”

Requests for Tumor Marker Tests in Turkey Without Indications and Frequency of Elevation in Benign Conditions

“…As a result of being retrospective, our study has revealed no information about the incidence of malignancy in ovarian cyst patients with high CA 125 levels or whether or not they underwent operations. This marker does not increase in megaloblastic anemia (Symeonidis et al, 2004). Literature does not confirm whether CA 125 levels are elevated or not in patients with other types of anemia.…”

“…In a previous study, the level of CA 19-9 was found to be elevated in 13 (3%) of patients with pneumonia (Marechal et al, 1988). It has been reported that in megaloblastic anemia the levels of CA 19-9 were not increased (Symeonidis et al, 2004). This marker was found to be sporadically high in patients with beta thalassemia (Christoforidis et al, 2007).…”

“…The CEA level was found to be higher in patients with pneumonia than in healthy patients (Shiota et al, 1989). Literature confirms that the CEA level does not increase in megaloblastic anemia (Symeonidis et al, 2004). In iron deficiency anemia, the CEA level was found to be elevated in gastrointestinal-related lesions (peptic ulcers, celiac disease, familial polyposis coli, etc) (Serefhanoglu et al, 2010).…”

“…It has been found to be high in benign conditions, especially in cases of anemia, pneumonia, and pleural effusions. CA 15-3 was found to be high in megaloblastic anemia (Triantafillidis et al, 2002;Symeonidis et al, 2004). This marker was found to be elevated in patients with beta thalassemia (Symeonidis et al, 2006).…”