Marrow Acid Phosphatase. Accurate staging of prostatic cancer is important for determining treatment. Since the skeletal survey by routine radiography may be negative until approximately 40 percent of bone is involved with tumor, other tests, including marrow acid phosphatase, are used for the detection of early bone metastasis in patients with prostatic cancer. An elevated bone marrow acid phosphatase follows dissemination of prostatic cancer to the marrow space and contraindicates radical surgery in these patients. Normal values for marrow acid phosphatase are the same as for serum acid phosphatase.

Hormonal/Steroid Studies. Certain malignancies are quite apt to change the levels of hormones and/or steroids produced in the body. A study of the hormone/steroid composition of the urine can sometimes be used to infer the presence of such a malignancy.

There are more and more instances when you will have to abstract a report of a hormone or steroid study. Hormone studies may be used as an aid in diagnosing tumors of the adrenal cortex, pancreas, uterus, and testis.

Bilirubin. Bilirubin is a pigment excreted normally by the gallbladder and liver. An elevated bilirubin is indicative of obstruction of the gallbladder or of hepatic disease which affects the function of the liver. Normal values are: One min. 0.4 mg/100 ml. Direct: 0.4 mg/100 ml. Total: 0.7 mg/100 ml. Indirect is total minus direct.

BUN (Blood urea nitrogen). An elevated BUN may result in uremia reflecting the failure of the kidneys to excrete normal waste materials. For example, it occurs frequently in patients with cancer of the cervix and bladder where extensive growth of the cancer obstructs the ureters. Normal values are 8-25 mg/100 ml.

Uric Acid. In any malignancy with rapid destruction of cells, uric acid may be elevated. It is of particular interest in patients with lymphoma, Hodgkin disease, lymphosarcoma, polycythemia vera, and leukemia treated by radiation therapy and/or chemotherapy. Normal values are 3.0-7.0 mg/ml.

Total protein. This test measures the amount of total circulating protein (albumin and globulin) in the patient's blood serum. It is elevated in multiple myeloma. Low total protein (low level of albumin) is associated with pleural effusion and ascites. Normal values are 6.0-8.0 mg/100 ml.

LDH (Lactic acid dehydrogenase). LDH is an intracellular enzyme which occurs in many body cells. An elevated LDH is indicative of increased cell destruction, possibly from metastatic spread of cancer. Normal values are 60-100µ/ml.

SGOT (Serum Glutamic-oxalacetic-transaminase). This is an enzyme which is specifically manufactured in the liver. It is elevated when the liver does not function normally. Normal values are 10-40100µ/ml.

CEA (Carcino-embryonic-antigen). This term was first used in 1965 to describe a glyco-protein which is present in extracts of carcinoma cells. An elevated CEA may be indicative of cancer of the gastrointestinal tract and, occasionally of the breast, lungs, and female reproductive system. When the entire malignancy is removed, the CEA level may drop; it may rise when recurrence or metastasis develops. Normal values are 0-2.5 mg/ml. However, CEA titers less than 2.5 mg/ml are not proof of the absence of malignant disease. Normal values do not apply if the patient is a smoker.