Baseline Lab Testing
Laboratory testing can provide us with a significant amount of information, and is ideally the first place to start after being diagnosed with cancer. Our baseline lab panel, which is performed via blood testing, consists of a very thorough investigation into how the body is working. Below are some of the most important blood tests we order on our patients. Please note that this does not represent an exhaustive list, and does not include specialty labs we routinely obtain.
Complete Blood Count with Differential
This panel, often abbreviated as a CBC, provides important information about the body’s cells, several of which are very important when dealing with cancer. This panel measures the white blood cell level, which is a key marker of general immune system function. Included in this panel are the different types of immune system cells, including neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Each of these cells should be present in the body in specific amounts. Any abnormalities can signal an issue with the immune system, including a problem with the bone marrow where immune system cells are made.
The CBC also includes a measurement of the body’s red blood cells, which are the oxygen-carrying cells of the body. Red blood cells also contain iron. In addition, this panel measures hemoglobin and hematocrit, both of which reflect the body’s iron levels. Many cancer patients have low iron, which is reflected by low values here. As with the immune system cells, derangements here can signal an issue in the bone marrow where these cells are made.
Comprehensive Metabolic Panel
Often abbreviated as a CMP, the comprehensive metabolic panel evaluates key markers of the body’s normal functioning. This panel includes a blood glucose (i.e., blood sugar) level, as well as markers of proper kidney and liver health. In addition, electrolytes including sodium and potassium are evaluated. This is a standard lab panel that most doctors will draw.
Of particular importance in this section is the albumin level. Albumin is a protein which is commonly used to evaluate liver health. However, it is also a marker of nutritional status, and many oncologists are unaware that decreases in albumin can signal a progression of cancer.
Often abbreviated as CRP, this lab test measures cellular inflammation, which is extremely important since we know that cancer is an inflammatory disease. Although cancer is not the only condition which can cause an increase in cellular inflammation, we have found that almost all cancer patients will have an elevated CRP. Striving to reduce CRP to more manageable levels should be one of the goals of treatment, since inflammation is not only consistent with cancer’s presence, but also one factor used for its spread.
Ceruloplasmin is a liver protein that is responsible for storing and carrying copper throughout the body. Although the body needs some copper in order to carry out various processes, we do not want too much copper because cancer requires it for angiogenesis. Recall that angiogenesis is the formation of new blood vessels by cancer. The process of angiogenesis is a key component of cancer’s growth and spread throughout the body.
The hemoglobin A1c level provides valuable information about blood sugar control. In contrast to the blood glucose level, which is simply a blood sugar level at the time the blood was obtained, the hemoglobin A1c reflects the blood sugar over the previous three months. The hemoglobin A1c is the main way we diagnose type II diabetes today, because we know that diabetes is a disease of poor blood sugar control.
The higher the hemoglobin A1c level, the higher the blood sugar, and the poorer the patient’s blood glucose control. We know that cancer loves sugar, and uses it as a preferred fuel source. Not surprisingly, having type II diabetes is associated with an increased risk of developing cancer. However, simply avoiding the diagnosis of diabetes does not eliminate the risk for cancer. Interestingly, even those individuals in the high-normal hemoglobin A1c range have also been shown to be at increased risk of developing cancer.
There are many hormones in the body, and they each perform various functions. Establishing a baseline level of hormones is especially important when dealing with those cancers which are frequently fueled by hormones, including breast, ovarian, and prostate.
Insulin-like Growth Factor 1
This lab test, also known as IGF-1, is a surrogate marker for growth hormone. Many cancers over-express IGF-1, meaning that we can use it to assess the extent of cancer in the body.
We know that iron can serve as fuel for cancer cells, and although the body needs some iron, we do not want too much. Iron studies typically include iron, total iron binding capacity, transferrin, transferrin saturation, and ferritin. Each of these measurements reflects iron in its different forms found inside the body. This complete panel of iron levels gives us valuable information as to the overall iron status. This is especially pertinent, since chronic illnesses such as cancer can create a condition known as anemia of chronic disease.
Frequently abbreviated as LDH, lactate dehydrogenase is another lab test which can be used to evaluate the extent of cancer. Although it is a non-specific test (i.e., it can be elevated in non-cancerous conditions as well), we have found that it is still helpful to measure when monitoring treatment progress. One study found that a high level of LDH in cancer patients corresponds to a greater risk of death.
The lipid panel, also referred to as a cholesterol panel, includes total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. Despite recommendations over the past 50 years for cholesterol to be minimized, studies have actually shown that people with higher cholesterol live longer. With respect to cancer, multiple studies have shown that cancer development is associated with low cholesterol, and that this low cholesterol level often precedes the cancer diagnosis by decades.
Although they are not considered diagnostic, applicable tumor markers should be obtained soon after diagnosis to establish a baseline level. When elevated, monitoring them regularly can provide a way of assessing response to treatment. The main tumor markers are AFP, CA 125, CA 15-3, CA 19-9, CA 27.29, CEA, and PSA.
This vitamin is important for a variety of important bodily processes, and many people supplement their diets with B12. However, elevated vitamin B12 levels have been associated with an increased risk of cancer. One study found that those subjects with the highest B12 levels had the highest risk of developing cancer. Most of these cancer diagnoses were made within the first year of follow-up. Whether due to causation or simply correlation, it is important to avoid extreme levels of B12 in the body.
Vitamin D is a very important marker. We have long known that vitamin D is necessary for bone integrity, but research in recent years has revealed that vitamin D is also very important for proper immune system functioning. There is also research that vitamin D plays a protective role against heart disease and dementia. For our purposes in treating cancer, we strive for an optimal range which properly stimulates the immune system (more isn’t always better!).