Understanding your blood test results; when you have cancer

A simple guide, in easy-to-understand-language, of the core measurements in your blood tests when you have cancer; an explanation of what to look for and what not to worry about!

All good blood tests will provide you with a range for each measurement - a high end and a low end figure. Most blood tests with cancer patients start off with red and white cell measurements

1. WBC; This is a measure of the total white blood cell count in your blood. Young people would be expected to have higher levels. However, if you have low levels, this could indicate that you have an infection, an auto-immune disease, or inflammation, or certain cancers, or your cells are being decreased by cancer treatment. However, a high level can be due to infection, bone marrow disease, stress, smoking or drugs. There are three types of white cell - granulocytes, monocytes and lymphocytes. 

   1. Platelets - platelets are white blood cells that bind together to stop us from bleeding. To do this, they change shape and grow ‘tentacles’ forming a clot. Very low levels are a concern because you might bleed too much. But high levels might indicate a risk of DVT or stroke. Cancer uses platelets to help form blood supplies, to grow and to spread. There is research with Dipyridamole (an antiplatelet drug being used effectively against myeloma; turmeric may lower platelets slightly, but many cancer treatments can lower platelet levels significantly. Papaya Leaf extract can raise levels.

   2. Lymphocytes - there are three types - B-lymphocytes, T-lymphocytes or Natural Killer cells. High levels may occur after an illness, but can indicate infection, allergies, Hepatitis, CMV, EBV or even Lymphoma or Leukaemia. Low levels (e.g  Lymphocytopenia) can lead to repeated parasitic, viral, fungal or bacterial infections.

   3. Neutrophils - the most common white blood cell in your body; they fight infection and heal injury. They are a type of granulocyte, and appear out of the bone marrow at the first sign of infection. Neutropenia is where you have a low neutrophil level and results in repeated infections. Other causes of low neutrophils include low B-12, low copper, auto-immune diseases, chemotherapy, sepsis and hepatitis. Too high a level indicates that you probably have a bacterial or fungal infection or you’ve broken a bone or damaged a tissue. Fevers, sores, swelling and infections indicate levels may not be perfect. But high levels may be caused by drugs and certain cancers such as leukaemia.

   4. Monocytes - again these are white blood cells made in the bone marrow, but these can form macrophages which attack and gobble up germs

   5. Basophils  - high levels indicate infection - these cells secrete chemicals to neutralise infections and allergies.

   6. Eos may increase with cancer - they respond to allergies and cancer cells

2. RBC; This is a measure of the total red blood cells in your blood. Red cells carry your oxygen. A low level might indicate an infection or anaemia.But high levels too may indicate that something irseventing your cells getting enough oxygen. RBC is studied with the following 4 measurements - 

   1. Haemoglobin - This goes hand in hand with the RBC measurement. A low level indicates anaemia; a high level might indicate you live at altitude, you smoke, you are dehydrated or have an illness.

   2. Ferritin - This is a blood protein that stores and transports iron safely. It plays a role in immune response, infection and inflammation. If your levels are low, it indicates your iron stores are low. If high, it could be due to an illness (Hypothyroidism, liver disease, kidney disease,diabetes, atherosclerosis, inflammatory disease, Rheumatoid arthritis), It may be caused by haemochromatosis, a genetic disease more common in Northern Europeans. In cancer, ferritin may play a role in proliferation, angiogenesis, immunosuppression, and iron delivery to cancer cells - higher levels are found in  many cancer patients, and have been linked to aggressive disease and poor clinical outcome (1).

   3. Hematocrit -  This measures the proportion of the red cells to others in your blood.

   4. MCV - Mean Corpuscular Volume measures the average size of your red blood cells. A low or high figure can indicate a disorder - for example anaemia - or a lack of certain vitamins (e.g. B-12) or an autoimmune disease like coeliac or Chohn’s disease, or even a thyroid problem. 

   5. MCH -  Mean Corpuscular Haemoglobin gives you are reading of how much haemoglobin is in your red blood cells. A low level typically indicates an iron deficiency. In rare cases this may be caused by a genetic illness called Thalassemia. Both are linked to chest pain, shortness of breath and fatigue. High MCH is usually caused by not producing enough red cells. It can interfere with heart function causing palpitations, or fatigue.

   6. MCHC - Mean Corpuscular Haemoglobin Concentration measures the concentration of haemoglobin present. High or Low scores can indicate anaemia. This test will be specifically ordered is the patient has light-headedness, pale palour, fatigue or low Haemoglobin levels.

3. Metabolic Measurements

1. BUN - Blood Urea Nitrogen - the end product of breaking down protein and kidneys remove it. If higher than normal it would indicate your kidneys might not be functioning perfectly. This can be linked to pain when you urinate and/or fatigue.

2. Creatinine - From the activity of muscles, again a higher than normal level might indicate a kidney problem.

3. Protein, Globulin, Albumin - The kidneys filter protein from the blood. Total protein is the summation of Globulin and Albumin levels. Higher levels can simply indicate that you do not drink enough water, as levels in the blood are linked to osmosis.

4. Bilirubin - is the breakdown product of old red blood cells which has been processed by the liver and into the bile to leave the body. High or Low levels in the blood indicate the breakdown and elimination process is not working properly.

5. Electrolytes - Chloride, Sodium, Potassium and Bicarbonate - help control the pH of your blood and keep nerves and muscles functioning properly. A divergence of these can be linked to drugs, heart, liver or kidney disease, high blood pressure and stress.

6. Alkaline Phosphatase - ALP is an enzyme found throughout the body, although it is often linked mainly to the liver. High levels may indicate liver disease or bone issues. In cancer patients, if high, it may be an indicator that something is happening in either (see CA15-3 below). ALT and AST are two other liver enzymes, denoting liver health.

4. Cancer Blood Tests

1. CEA - Babies are born with quite high levels of Carcinoembryonic Antigen levels and it tends to decrease as we age. It never goes to zero. It can increase simply because you smoke; and, yes, if there is a cancer in your body. It’s a protein with lots of sugars added to it (a glycoprotein). Healthy cells can make it, not just cancer cells. CEA can be called a Tumour Marker and you should be in ‘Normal’ range.

2. CA 27-29 and CA15-3 - CA 15-3 is another glycoprotein produced by the eyes, lungs, intestines and other ‘epithelial’ lining cells. It can be overproduced in breast, lung, ovarian and pancreatic cancers. Again the score is never zero; you need to be ‘in range’. CA27-29 is often linked to CA15-3 because of the glycoprotein (Mucin) measured.  However, be clear - both CA 15-3 and CA 27-29 may be elevated in people with benign ovarian cysts, benign breast disease, and benign liver disease (cirrhosis);  elevated levels are also found in people with sarcoidosis and lupus. CA15-3 coupled with higher levels of Alkaline Phosphatase was found to be an early indicator of breast cancer recurrence (2).

3. CA-125 - A CA-125 test alone cannot diagnose cancer. Levels increase if you are having a menstrual period, or have liver issues, uterine fibroids, endometriosis or pelvic inflammation. Tests can measure Cancer Antigen 125, a protein that triggers the immune system, when present in the blood. CA-125 can be found in higher levels in the blood of women with ovarian cancer. 

4. CA 19-9 - Levels of this protein may be elevated simply because of gallstones, cystic fibrosis, pancreatitis, liver or bile duct disease. However, higher levels can be indicative of a cancer - for example, Pancreatic cancer, lung cancer, gastric cancer, ovarian cancer, bladder cancer, gallbladder/bile duct cancer or colorectal cancer.

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References

1. The significance of ferritin in cancer: Anti-oxidation, inflammation and tumorigenesis - Bichimica and Biophysica Acta; Vol 1836; 2013 245-254. https://www.sciencedirect.com/science/article/abs/pii/S0304419X13000395 
2. CA15-3 and alkaline phosphatase as predictors for breast cancer recurrence: a combined analysis of seven International Breast Cancer Study Group trials - Keshaviah et al. 18 (4): 701 - Annals of Oncology. 2007
3. The Mayo Clinic - Complete Blood Count 
4. The Cleveland Clinic - Complete Diagnostic Blood Tests
5. Healthline - https://www.healthline.com/health/blood-tests 

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