Table 5

Peptide markers specific to the tumour site

SiteTypeLaboratory tests requiredResults expected
GastricI and IICgA, gastrinRaised
IIICgA, gastrinRaised CgA, gastrin not raised
DuodenalCgA, gastrin, PP, urinary 5-HIAA, SOMRaised CgA in 90%
Consider MEN1
Jejunal, ileal and proximal colonCgA, urinary 5-HIAA, NKARaised CgA (>80%), U-5-HIAA (70%) and/or NKA (>80%); see text
Proximal colonCgA, urinary 5-HIAA, NKA, (PP)Raised CgA (>80%), U-5-HIAA (70%) and/or NKA (>80%); see text
AppendicealCgA, urinary 5-HIAA, NKA, (PP)None raised unless metastatic
Metastatic: markers as ileal
Goblet cellCgA, urinary 5-HIAA, NKA, (PP)None raised
RectalCgA, CgB, PP, glucagon, HCG-βRaised CgA (rarely); see text
Raised CgB, PP, glucagon and/or HCG-β in some
PancreaticCgARaised CgA in metastatic tumours only
InsulinomaCgA, insulin, blood glucose,Insulin inappropriate to glucose; see text
C peptide or pro-insulinRaised C peptide and pro-insulin
GastrinomaGastrinRaised gastrin; see text
GlucagonomaGlucagon, enteroglucagonRaised glucagon
SomatostatinomaSOMRaised SOM
PPomaPPRaised PP
MEN1CgA, gastrin, (calcium, PTH), insulin, glucagon, PP
  • Items in parentheses may be helpful for diagnosis and monitoring in individual patients.

  • CgA, chromogranin A; CgB, chromogranin B; HGC-β, human chorionic gonadotrophin β; 5-HIAA, 5 hydroxyindoleacetic acid; NKA, neurokinin A; PP, pancreatic polypeptide; PTH, parathyroid hormone; SOM, somatostatin; VIPoma, vasoactive intestinal peptide-secreting tumour.