Which lab studies are indicated in the workup of rectal cancer?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Routine laboratory studies should include a complete blood count (CBC); serum chemistries, including liver and kidney function tests; and a carcinoembryonic antigen (CEA) test. A cancer antigen (CA) 19-9 assay, if available, may also be useful to monitor the disease.

Screening CBC may demonstrate a hypochromic, microcytic anemia, suggesting iron deficiency. The combined presence of vitamin B12 or folate deficiency may result in a normocytic or macrocytic anemia. All men and postmenopausal women with iron deficiency anemia require a GI evaluation.

Liver function tests are usually part of the preoperative workup. The results are often normal, even in patients with metastases to the liver.

Perform a CEA test in all patients with rectal cancer. A baseline level is obtained before surgery and a follow-up level is obtained after surgery. If a previously normalized CEA begins to rise in the postoperative period, this suggests possible recurrence. A CEA level higher than 100 ng/mL usually indicates metastatic disease and warrants a thorough investigation. The steps of the workup are outlined in Figure 1.

Diagnostics. Staging and workup of rectal cancer patients.

Diagnostics. Staging and workup of rectal cancer p Diagnostics. Staging and workup of rectal cancer patients.

Fecal immunochemical tests appear to be accurate for detecting colorectal cancer. In a meta-analysis that examined 8 different brands of fecal immunochemical tests (FITs), Lee and colleagues found that FITs had high accuracy, high specificity, and moderately high sensitivity for the detection of colorectal cancers. [34, 35] The meta-analysis, which included 19 studies with sample sizes ranging from 80 to 27,860, showed that FITs had sensitivity of 0.79, specificity of 0.94, a positive likelihood ratio of 13.10, and a negative likelihood ratio of 0.23. The overall diagnostic accuracy of FITs was 95%.


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