About markers in general surgery

  • Carlos Costa Almeida Director de Serviço (Cirurgia C) do CHUC – Hospital Geral, Professor da Faculdade de Medicina de Coimbra, Portugal


Some considerations are made on markers sensu lato – substances or situations in the organism, related with a certain nosological entity and that can draw attention to it or help to its diagnosis and evaluation – and the importance they must have in general surgery.
Frequently their use is restricted to the biological markers, specially related with tumours, but there is much more than that. A relevant example is the ankle/arm pressure index (AAI), that means lower limb ischemia but is also a marker for atherosclerotic disease, of any localization, already symptomatic or not, and, besides that, an independent predictive factor of cardiovascular mortality: the lesser is its value, the bigger is the risk. Its routine measurement in surgical patients with atherosclerotic risk is, therefore, a medical act that can definitely concur in a very important way to take measures that can help the patient to bear our surgical intervention in the best possible security conditions. Another important example is venous thrombosis, either superficial or deep (venous thromboembolism, VTE), as a tumour marker. Any of them can precede the specific manifestations of the oncologic disease. And, at the same time, some cancers constitute a relevant thrombotic factor, VTE being, in these cases, beyond a marker, a factor for worse oncological prognosis, what implies a redoubled care with its prophylaxis, immediately after the diagnosis and not only pre-operatively, and a fortiori when the already identified thrombotic biomarkers in oncological pathology are present. Concerning tumour biomarkers, the most usually used are listed, in groups, according to their nature. Their utilization is useful, but one should not confuse what we would like them to be with what they really are. With exception of some individual characteristics, specially involving the volume of the tumour, prognosis, orientation of treatment and forecast of its result, what tumor biomarkers consistently give us is information on the immediate result of treatment and, during follow-up, the early detection of recurrence or late metastasis. They must be used as reference for future and, therefore, after a tumour is diagnosed, and before any treatment, it is absolutely mandatory to search for and measure the biomarkers with it usually related.

Keywords: Marker, Tumour, Cancer, Atherosclerosis, Venous thrombosis, Ankle-arm pressure index, General Surgery


Download data is not yet available.


Alberts M J, Bhatt D L, Mas J-L, Ohman E M, Hirsch A T, Röther J, Salette G, Goto S, Smith Jr S C, Liau C, Wilson PWF, Steg Ph G, for the REduction of Atherothrombosis for Continued Health (REACH) Registry Investigators. Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry Eur Heart J. 2009 Oct; 30(19): 2318–26.

Alcalay A, Wun T, Khatri V, Chew HK, Harvey D, Zhou H, White RH. Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol. 2006;24:1112–8.

Al-Qaisi M, Nott DM, King DH, Kaddoura S. Ankle brachial pressure index (ABPI): An update for practitioners. Vasc Health Risk Manag. 2009; 5: 833-41

Bădulescu F, Bădulescu A, Crişan A, Popescu FC. Study of the diagnosis and treatment of cancer located in the head and neck and correlation with expression of prognostic markers. Rom J Morphol Embryol. 2013;54(3):487-97.

Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, Goto S, Liau CS, Richard AJ, Röther J, Wilson PW; REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006 Jan 11; 295(2):180-9.

Carter HB. American Urological Association (AUA) Guideline on prostate cancer detection: process and rationale. BJU Int. 2013 Sep;112(5):543-7.

Chen H, Zhen Z, Todd T, Chu PK, Xie J. Nanoparticles for Improving Cancer Diagnosis. Mater Sci Eng R Rep. 2013 Mar;74(3):35-69

Connolly GC, Menapace LA, Sousou T, Safadjou S, Khorana AA. Incidental and symptomatic venous thromboembolic events are associated with increased mortality in lung cancer patients. J Thromb Haemost. 2011;9(Suppl 2):52.

den Exter PL, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol. 2011; 29(17):2405-2409.

Duffy MJ. Tumor markers in clinical practice: a review focusing on common solid cancers. Med Princ Pract. 2013;22(1):4-11

Filippella M, Lillaz E, Ciccarelli A, Giardina S, Massimetti E, Navaretta F, Antico A, Veronesi M, Lombardi G, Colao A, Ghigo E, Benso A, Doveri G. Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients. J Endocrinol Invest. 2007 Oct; 30(9): 721-5

Gara S, Boussen H, Ghanem A, Guemira F. Use of common seric tumor markers in patients with solid cancers. Tunis Med. 2008 Jun;86(6):579-83

Gomella LG, Liu XS, Trabulsi EJ, Kelly WK, Myers R, Showalter T, Dicker A,Wender R. Screening for prostate cancer: the current evidence and guidelines controversy. Can J Urol. 2011 Oct;18(5):5875-83.

Gupta N, Dasyam AK, Carty SE, Nikiforova MN, Ohori NP, Armstrong M, Yip L,LeBeau SO, McCoy KL, Coyne C, Stang MT, Johnson J, Ferris RL, Seethala R, Nikiforov YE, Hodak SP. RAS mutations in thyroid FNA specimens are highly predictive of predominantly low-risk follicular-pattern cancers. J Clin Endocrinol Metab. 2013 May;98(5):E914-22.

Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev. 2013 Jan 31;1:CD004720.

Kawai K, Watanabe T . Colorectal cancer and hypercoagulability. Surg Today. 2013 May 14

Koh J, Choi JR, Han KH, Kim EK, Yoon JH, Moon HJ, Kwak JY. Proper indication of BRAF(V600E) mutation testing in fine-needle aspirates of thyroid nodules. PLoS One. 2013 May 24;8(5):e64505.

Marchetti I, Iervasi G, Mazzanti CM, Lessi F, Tomei S, Naccarato AG, Aretini P, Alberti B, Di Coscio G, Bevilacqua G. Detection of the BRAF(V600E) mutation in fine needle aspiration cytology of thyroid papillary microcarcinoma cells selected by manual macrodissection: an easy tool to improve the preoperative diagnosis. Thyroid. 2012 Mar;22(3):292-8.

Menapace LA, Peterson DR, Berry A, Sousou T, Khorana AA. Symptomatic and incidental thromboembolism are both associated with mortality in pancreatic cancer. Thromb Haemost. 2011;106(2):371-378.

Monreal M, Lensing AW, Prins MH, Bonet M, Fernández-Llamazares J, Muchart J, Prandoni P, Jiménez JA. Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism. J Thromb Haemost. 2004;2:876–81.

Nieswandt B, Hafner M, Echtenacher B, Männel DN. Lysis of tumor cells by natural killer cells in mice is impeded by platelets. Cancer Res. 1999;59:1295–300

Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011;105(Suppl 1):S13–33.

O’Connell C, Razavi P, Ghalichi M, Boyle S, Vasan S, Mark L, Caton A, Duddalwar V, Boswell W, Grabow K, Liebman HA. Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost. 2011;9(2):305-311

Palumbo JS, Talmage KE, Massari JV, La Jeunesse CM, Flick MJ, Kombrinck KW, Jirousková M, Degen JL. Platelets and fibrinogen increase metastatic potential by impeding natural killer cell-mediated elimination of tumor cells. Blood. 2005;105:178–85.

Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P. Clinical Guidelines Committee of the American College of Physicians. Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2013 May 21;158(10):761-9.

Sasaki K, Kawai K, Tsuno NH, Sunami E, Kitayama J. Impact of preoperative thrombocytosis on the survival of patients with primary colorectal cancer. World J Surg. 2012;36:192–200.

Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000 343(25): 1846-50

Stender MT, Frøkjaer JB, Larsen TB, Lundbye-Christensen S, Thorlacius-Ussing O. Preoperative plasma D-dimer is a predictor of postoperative deep venous thrombosis in colorectal cancer patients: a clinical, prospective cohort study with one-year follow-up. Dis Colon Rectum. 2009;52(3):446-451.

Theoharis C, Roman S, Sosa JA. The molecular diagnosis and management of thyroid neoplasms. Curr Opin Oncol. 2012 Jan;24(1):35-41.
How to Cite
ALMEIDA, Carlos Costa. About markers in general surgery. Revista Portuguesa de Cirurgia, [S.l.], n. 26, p. 31-36, jan. 2014. ISSN 2183-1165. Available at: <https://revista.spcir.com/index.php/spcir/article/view/318>. Date accessed: 24 apr. 2024.
Review Article