SEER Training Modules

Blood Serum Studies

Automation and modern advances in medical technology enable the physician to obtain a complete battery of laboratory tests from the patient's blood. Listed below are a few of the studies you may want to check to assess the diagnosis or spread of cancer.

Serum Calcium

Calcium circulated in the blood in equilibrium with the calcium in the bone. Patients with cancer have a tendency to develop an excess of calcium in the blood (hypercalcemia), particularly with lung and breast cancers, reflecting metastatic disease of the bone. When bone is replaced with malignant cells, calcium is released in an increased amount in the blood circulation. Normal values are 8.5-10.5 mg/100 ml (slightly higher for children).

Serum Alkaline Phosphatase

Alkaline phosphatase is an intercellular enzyme which becomes elevated when there is destruction of cells. The key areas where it is produced are the liver and bones. An elevated alkaline phosphatase is indicative of bone and liver abnormalities. See the table below for normal values.

Serum Acid Phosphatase

Elevated serum levels of acid phosphatase are seen in patients with carcinoma of the prostate that has extended beyond the prostatic capsule. Patients with prostatic carcinoma still confined within the capsule usually have a normal serum acid phosphatase level. However, patients with benign prostatic hypertrophy may have slight elevations of the serum acid phosphatase level after vigorous prostatic "massage". Since other tissues may also release acid phosphatase into the blood serum, minor elevations may reflect an origin other than the prostate. Serum acid phosphatase studies have been used diagnostically to help determine the resectability of prostatic cancers. Cancers which have extended beyond the prostatic capsule, i.e., to the bone, are not generally treated by prostatectomy. See the table below for normal values.

There are different methods for determining the alkaline phosphatase and acid phosphatase levels in the blood. Commonly used are the Bodansky and the King-Armstrong methods. It is necessary to know the method used and the normal values in order to interpret your hospital's test results.

Normal Alkaline and Acid Phosphatase Values (by Method)

Serum alkaline phosphatase Adults 2 - 4.5 units
Children 5 - 14 units
Serum acid phosphatase   0.5 - 2.0 units
Serum alkaline phosphatase Adults 4 - 13 units
Children 15 - 20 units
Serum acid phosphatase   1 - 5 units
Serum alkaline phosphatase Adults 0.8 - 2.3 units
Children 3.4 - 9 units
Serum acid phosphatase   0.10 - 0.63 units
Serum alkaline phosphatase   3.0 - 10.0 units
Serum acid phosphatase   0.5 - 2.0 units
Serum alkaline phosphatase   2.2 - 8.6 units
Serum acid phosphatase   0.0 - 1.1 units
International Units
Serum alkaline phosphatase   21 - 91 U/L at
37° C incubation
Serum acid phosphatase   0.2 - 1.8