1st order laboratory parameters – obligatory laboratory tests.
- Biopsy (tissue sample) – to determine the type of tumor as well as its aggressiveness; most important diagnostic measure in cases of suspected tumor; performed following imaging procedures (see “Medical Device Diagnostics“).
- Alkaline phosphatase (AP) isoenzymes, ostase, urinary calcium (the tumor hypercalcemia (synonym: tumor-induced hypercalcemia, TIH) is one of the most common symptoms in paraneoplastic syndromes), PTHrP (parathyroid hormone-related protein; the constellation with decreased parathyroid hormone (PTH) and increased PTHrP is typical of tumor hypercalcemia) – in suspected bone metastases, bone tumors (osteosarcoma).
- Bence-Jones proteins in the urine (plasmocytoma/multiple myeloma).
- Deoxypyridinoline (DPD) – is > 98% bone specific – a good index of bone resorption rate(increased in: peri- and postmenopausal osteoporosis (early detection possible if bone densitometry is still normal); bone metastases; plasmocytoma (synonym: multiple myeloma); Paget’s disease; primary hyperparathyroidism (parathyroid hyperfunction).
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- Parathyroid hormone – to exclude hyperparathyroidism, in the context of which osseous manifestations of the disease may occur: Osteodystrophia cystica generalisata von Recklinghausen (hemorrhaged resorption cysts = brown tumors with irregularly distributed giant cell clusters) (rather rare) (giant cell tumor/osteoclastoma).
- Immunohistochemical detection of mutant H3.3 histone protein – in unclear cases (giant cell tumor (osteoclastoma), chondroblastoma).
- Wg. possible anemia (anemia): small blood count, ferritin* , folic acid, vitamin B12, reticulocytes.
* Low ferritin levels may be “masked” by inflammatory responses. Therefore, the assessment of ferritin should be performed in parallel with C-reactive protein (acute phase protein), if necessary.
