Colon and Rectal Cancer

Methylated Septin 9 is a DNA marker associated with colorectal cancer.

Description: Fecal Globulin by immunochemistry is a test that measures the amount of blood present in fecal samples. The results from the fecal globulin test can be used to detect a lower gastrointestinal disorder. It is recommended to be a part of the routine physical examination.

Also Known As: Fecal Immunochemical Test, Fecal Occult Blood Test, Stool Occult Blood Test, FIT, FOBT

Collection Method: Fecal specimen collected from toilet water and brushed onto InSure® FOBT test card

Specimen Type: Fecal Specimen

Test Preparation: No preparation required

When is a Fecal Globin test ordered?

When a person chooses fecal occult blood testing as a method of colon cancer screening, the American Cancer Society and other major healthcare organizations recommend yearly testing. The American Cancer Society and others recommend that colon cancer screening begin around age 50 for the general population, but it may begin earlier if a person has a family history of colon cancer.

An FOBT may be ordered by a doctor if a patient has unexplained anemia that could be caused by gastrointestinal bleeding.

What does a Fecal Globin test check for?

The majority of colon cancer cases begin with the formation of benign intestinal polyps. Benign polyps are quite common in adults over 50, and while the majority do not cause health problems, some can turn malignant and spread to other parts of the body. These finger-like growths protrude into the rectum or the intestinal cavity. They can be delicate and bleed on occasion, as when food debris rubs against them.

The blood expelled is normally not visible in the stool, but a fecal occult blood test or a fecal immunochemical test can detect it. The FOBT and FIT are effective colorectal cancer screening techniques because this small amount of blood may be the earliest and sometimes only evidence of early colon cancer. A guaiac-based test, an over-the-counter flushable reagent pad, and an immunochemical technique are all options for testing.

It is advised that at least three stool samples be taken on different days be tested. According to the American Cancer Society, a single test performed during a digital rectal exam at a doctor's office is not recommended since it may not be sensitive enough to detect cancer. Because collecting feces on three different days increases the chances of identifying cancer, the home FOBT or FIT is advised. Additionally, those who choose this type of colon cancer screening should be screened every year.

Lab tests often ordered with a Fecal Globin test:

• Complete Blood Count (CBC)
• Calprotectin

Conditions where a Fecal Globin test is recommended:

• Colon Cancer

How does my health care provider use a Fecal Globin test?

The fecal occult blood test, also known as the fecal immunochemical test, is primarily used to screen for early colon cancer. The majority of colon cancer cases begin with the formation of benign intestinal polyps. People over the age of 50 are more likely to develop benign polyps. The majority are non-cancerous, however some can develop malignant.

Blood in the stool could be the only sign of early cancer, so if caught early, therapy can begin right away, increasing the chances of a cure.

What do my Fecal Occult Blood test results mean?

Normally, the fecal occult blood test is negative.

A positive test result for the guaiac-based FOBT shows that abnormal bleeding is occurring anywhere in the digestive tract. Ulcers, diverticulosis, polyps, inflammatory bowel disease, hemorrhoids, blood eaten owing to bleeding gums or nosebleeds, or benign or malignant tumors could all cause blood loss.

A positive result for the fecal immunochemical test shows abnormal bleeding in the lower digestive tract. Other sources of blood, such as those found in the diet, do not generate a positive result since this test only identifies human hemoglobin. Furthermore, hemoglobin from upper digestive tract hemorrhage is broken down before reaching the lower digestive tract and is undetectable by the FIT. As a result, the FIT is a more precise test than the gFOBT.

Follow-up testing is required after a positive result from either the guaiac-based FOBT or the immunochemical FIT. Direct imaging of the colon and rectum is generally used.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Description: CA 19-9 is a cancer antigen test that is testing for a protein that exists on the surface of certain cancer cells. The CA 19-9 test can be used to measure the level of these proteins in the blood and is useful as a tumor marker.

Also Known As: Carbohydrate Antigen (CA) 19-9 Test, Cancer Antigen 19-9 Test, Cancer Antigen (CA) 19-9, Carbohydrate Antigen 19-9 Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a CA 19-9 test ordered?

When a person has been diagnosed with pancreatic cancer or has signs and symptoms that could indicate pancreatic cancer, CA 19-9 may be ordered. Early warning signs and symptoms can be vague and ambiguous.

If CA 19-9 levels are initially increased in pancreatic cancer, a series of CA 19-9 tests may be conducted to assess response during therapy and on a frequent basis after treatment to assist detect recurrence.

When a healthcare practitioner suspects bile duct cancer in a person with a bile duct obstruction, CA 19-9 may be prescribed. CA 19-9 levels can spike due to non-cancerous reasons of bile duct obstruction, but they drop once the blockage is addressed. In these circumstances, re-checking CA 19-9 levels should be done at least a week or two after the blockage has been cleared.

What does a CA 19-9 blood test check for?

The protein cancer antigen 19-9 is found on the surface of some cancer cells. CA 19-9 does not cause cancer; rather, it is emitted by tumor cells and can be discovered in blood and other bodily fluids by laboratory tests. The level of CA19-9 is measured in this test.

Because CA 19-9 can be tested in the blood, it can be used as a tumor marker to track the progression of cancer. CA 19-9 levels are high in 70% to 95% of persons with advanced pancreatic cancer.

CA 19-9 levels may also be elevated in cancers of the gallbladder and bile ducts, colorectal cancer, gastric cancers, ovarian cancer, lung cancer, liver cancer, pancreatitis, thyroid disease, and liver disease, among other cancers, conditions, and diseases. CA 19-9 is found in trace levels in the blood of healthy humans. CA 19-9 cannot be utilized for screening or diagnosis by itself because it is not specific for pancreatic cancer.

Lab tests often ordered with a CA 19-9 test:

• Bilirubin
• Carcinoembryonic Antigen
• Hepatic Function Panel
• Tumor Markers

Conditions where a CA 19-9 test is recommended:

• Pancreatic Cancer
• Pancreatitis
• Colorectal Cancer
• Gastric Cancers
• Lung Cancer
• Ovarian Cancer
• Cystic Fibrosis
• Liver Cancer
• Thyroid Disease
• Liver Disease

How does my health care provider use a CA 19-9 test?

The CA 19-9 test, along with other tests like carcinoembryonic antigen, bilirubin, and/or a liver panel, can be used to evaluate and monitor someone who has been diagnosed with pancreatic cancer and is having treatment.

CA 19-9 can only be utilized as a tumor marker if it is produced in large amounts by the malignancy. CA 19-9 may be ordered to help evaluate and monitor persons with bile duct cancer because it is high in roughly 65 percent of those with this type of cancer.

The CA 19-9 test is insufficiently sensitive and specific to be used as a cancer screening test. Because non-cancerous diseases can induce elevated CA 19-9 levels, it is not yet effective for detection or diagnosis. Researchers are still looking at markers that can be used alone or in combination with CA 19-9 to help diagnose and screen for pancreatic cancer in its early stages, when it is most curable.

What do my CA 19-9 test results mean?

Healthy persons have low levels of CA 19-9, although numerous illnesses that affect the liver or pancreas can induce transitory spikes.

People with pancreatic cancer, other malignancies, and a variety of other diseases and ailments may have moderate to high levels. CA 19-9 levels are higher in cancers of the exocrine pancreas. This cancer develops in the tissues that manufacture food-digesting enzymes, as well as in the ducts that transport those enzymes to the small intestine. This kind of pancreatic cancer accounts for approximately 95% of all pancreatic cancers.

CA 19-9 levels that rise and then diminish over time may indicate that the treatment is functioning and/or that the malignancy was successfully removed during surgery. Levels that stay high or rise over time could suggest that treatment isn't working and/or that the cancer is reoccurring.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Description: CEA is a test that measures the levels of carcinoembryonic antigens in the blood. It is used to evaluate a person who has been diagnosed with cancer. The levels of CEA maybe elevated with certain types of cancer.

Also Known As: Carcinoembryonic antigen Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a CEA test ordered?

When a person is diagnosed with colon cancer or another type of cancer, a CEA test may be ordered. It will be evaluated before treatment begins and subsequently on a frequent basis to assess treatment success and detect recurrence.

When cancer is suspected but not yet diagnosed, a CEA test may be conducted. Although CEA can be increased with a variety of illnesses, this is not a popular usage for the test, it may provide additional information to a healthcare practitioner.

When a healthcare practitioner suspects that a cancer has metastasized, a CEA test may be conducted on a fluid other than blood.

What does a CEA blood test check for?

Carcinoembryonic antigen is a protein found in the developing tissues of a fetus. It drops to a very low level by the time a baby is delivered. CEA is generally seen in extremely low amounts in the blood of people, but it can be raised in cancer patients. This test examines the quantity of CEA in the blood to aid in the evaluation of cancer patients.

CEA is a tumor indicator. CEA was once assumed to be a particular marker for colon cancer, however subsequent research has revealed that an elevation in CEA can be detected in a variety of malignancies. Non-cancer disorders such as inflammation, cirrhosis, peptic ulcer, ulcerative colitis, rectal polyps, emphysema, and benign breast disease, as well as smokers, can cause an increase in CEA. As a result, it is ineffective as a general cancer screening tool, although it does play a role in assessing cancer therapy response. An initial CEA baseline test may be performed after a person has been diagnosed with cancer. If this level is raised, serial CEA testing may be used to track the cancer's progress as the patient receives treatment.

Lab tests often ordered with a CEA test:

• Tumor Markers
• CSF Analysis
• Body Fluid Analysis
• CA 19-9
• Calcitonin
• Alpha Fetoprotein
• Antiphospholipid Antibodies

Conditions where a CEA test is recommended:

• Colon Cancer
• Colorectal Cancer
• Pancreatic Cancer
• Ovarian Cancer
• Breast Cancer
• Thyroid Cancer
• Lung Cancer

How does my health care provider use a CEA test?

The carcinoembryonic antigen test can be utilized in the following situations:

• To keep track of the treatment of persons who have been diagnosed with colon cancer. It can also be used as a marker for rectum, lung, breast, liver, pancreatic, stomach, and ovary malignancies. Prior to therapy, a CEA test is usually ordered as a "baseline" measurement. If the level is high, the test can be used to track a patient's response to treatment and see if the cancer has advanced or returned.
• Cancer staging entails determining the size of the tumor as well as the extent to which it has spread.
• CEA testing in a bodily fluid sample can help doctors figure out if cancer has progressed to a body cavity like the chest or abdomen.
• In the examination of cancer, a CEA test can be performed in conjunction with other tumor markers.

CEA is not produced by all malignancies, therefore a positive CEA test does not always indicate cancer.

What do my CEA test results mean?

Monitoring treatment and recurrence: CEA levels that are first raised but later return to normal following treatment indicate that the cancer has been successfully treated. The first symptom of tumor recurrence is frequently a progressively rising CEA level.

Staging: People with smaller and early-stage tumors are more likely to have a normal or slightly raised CEA score on initial testing. A high CEA value is more probable in people with larger tumors, later-stage cancer, or cancers that have disseminated throughout the body.

Testing for metastasis: If CEA is found in a bodily fluid other than blood, the cancer has most likely migrated to that part of the body. If CEA is found in CSF fluid, for example, it could suggest that cancer has spread to the central nervous system.

Because not all malignancies produce CEA, it's possible to have cancer and a normal CEA at the same time. The test will be useless as a surveillance tool if a malignancy does not produce CEA.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

dsDNA Antibody is detected in patients with active systemic lupus erythematosus (SLE) and approximately 20% of patients with Mixed Connective Tissue Disease.

The fecal occult blood test is an immunochromatographic fecal occult blood test that qualitatively detects human hemoglobin from blood in fecal samples. This is a useful screening aid for detecting primarily lower gastrointestinal (G.I.) disorders that may be related to iron deficiency anemia, diverticulitis, ulcerative colitis, polyps, adenomas, colorectal cancers or other G.I. lesions that can bleed. It is recommended for use by health professionals as part of routine physical examinations and in screening for colorectal cancer or other sources of lower G.I. bleeding.

Galectin-3

Clinical Significance

A galectin-3 test may be ordered for the identification of individuals with chronic heart failure at elevated risk of disease progression.

Performing Laboratory 

Cleveland HeartLab, Inc 
6701 Carnegie Avenue, Suite 500
Cleveland, OH 44103-4623

PIK3CA mutation has been associated with poor prognosis in endometrial, breast and colorectal cancers. Mutations in exons 9 and 20 of PIK3CA ave also been associated with resistance to cetuximab therapy in patients with colorectal cancer.

TMAO (Trimethylamine N-Oxide)

Alternative Name(s)

Tri N-Oxide

Patient Preparation 

Patients should fast overnight and refrain from consuming fish or other seafood the day before the blood draw to avoid false elevations in TMAO.

Clinical Significance

Gut microbes live symbiotically within the human digestive tract and play important roles in host defense, immunity, and nutrient processing and absorption. The diverse community is unique to each person and influenced by both acute and chronic dietary exposures to various food sources. Nutrients such as phosphatidylcholine (also known as lecithin), choline, and L-carnitine are abundant in animal-derived products such as red meat, egg yolk and full-fat dairy products. When consumed, these nutrients are processed by gut bacteria resulting in the release of various metabolites including TMA (trimethylamine) into the blood. TMA is then transported to the liver where it is converted into TMAO (trimethylamine N-oxide) which has been shown to regulate various physiological processes involved in the development of atherosclerosis.

Uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) is primarily responsible for the glucuronidation and detoxification of SN-38, the active metabolite of irinotecan (Camptosar), used in the treatment of colorectal cancer. The TA-7 variant referred to as UGT1A1*28, is associated with reduced SN-38 glucuronidation and increased toxicity. Individuals homozygous for the UGT1A1*28 (TA-7) allele have Gilbert syndrome which is a mild form of hyperbilirubinemia.