P-120 - Serum alkaline phosphatase level as an early diagnostic tool in colorectal cancer

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Colon and Rectal Cancer
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Presenter B. Pavkovic
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors B. Pavkovic, L.K. Nenadic, M. Brankovic, M. Zaric, M. Brkic
  • Health Center, Belgrade/RS



Serum alkaline phosphatase (ALP) levels is frequently elevated in patients with colorectal cancer (CRC), especially in those with hepatic metastases. The significance of ALP as a nonspecific but very pointing diagnostic tool is not sufficiently well recognized.

The aim of study was to evaluate correlation between serum ALP levels as nonspecific blood test, fecal occult blood test (FOBT) as screening method for gastrointestinal bleeding, carcinoembryonic antigen (CEA) values as tumor marker and colonoscopy findings as final diagnostic procedure for CRC.


Medical records of patients with CRC presented at Health Center “Dr Simo Milosevic” during 2014 were retrospectively reviewed and statistical analysis was done to evaluate the significance of ALP as early diagnostic tool for CRC.

The normal range for ALP and CEA varies according to the performing laboratory, but usually ranges for ALP was quantified 50-136 U/L, and for CEA 2,5-5 ng/mL.


A total of 151 patients were included in study, aged 50-74 years.

Observed population consisted of 73 patients, 41 females (56%) and 32 males (44%), who underwent colonoscopy, which revealed the existence of tumor masses, and pathological findings confirmed malignancy.

Control group consisted of 78 patients, 42 females (54%) and 36 males (46%), from the general population, all without confirmed malignancy.

For a period of six months before further diagnostic procedures increased levels of ALP were recorded in 39 patients (53%) in observed population and in 13 patients (17%) in control group. There was statistically significant difference (p < 0,005).

CEA levels were elevated in 25 patients (34%) before colonoscopy is performed and it depends on the clinical stage of disease.

ALP levels were compared with CEA, which showed a correlation between increased levels of ALP with increased levels of CEA, so that 23 patients (92%) with elevated levels of CEA had also increased levels of ALP.

FOBT was positive in 70 patients (96%), and in all who had increased levels of ALP.


Increased levels of serum ALP is associated with CRC. It is nonspecific blood test, but should arouse suspicion of CRC among other pathologic entities.

It is advisable to use of serum ALP levels as early diagnostic tool for CRC, especially because it is a simple, low cost and relatively sensitive method.

Future studies involving evaluation of ALP in addition to CEA in patients with CRC are indicated, bearing in mind, not only diagnostic but also prognostic significance of ALP.