About markers in general surgery
Abstract
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
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