What is the ESR Level in Cancer Patients?

The erythrocyte sedimentation rate (ESR) is a low-cost and easy-to-perform blood test that aids in the detection of inflammation within the body. Although not disease-specific for any single disease, it can be a helpful marker to infer the existence of underlying disease, including malignancy. An elevated level of ESR can represent chronic inflammation, a condition that is often seen with tumour growth and development.

ESR is the speed at which red blood cells (erythrocytes) fall to the bottom of a test tube within an hour. During inflammation, certain proteins, most notably fibrinogen, cause red blood cells to clump together and settle more rapidly, leading to an increased erythrocyte sedimentation rate (ESR).

Even though ESR does not particularly diagnose a disease, it tends to alarm that something is not right in the body. Physicians use it alongside other tests to develop an effective clinical picture, especially when evaluating chronic illnesses like autoimmune diseases, infections, and cancers.

Inflammation and Cancer - The Missing Link

Chronic inflammation plays a central role in the initiation and development of the majority of cancers. Free radicals and cytokines generated from inflammatory cells have the capacity to damage DNA, to initiate mutations, and to drive proliferation - set nicely for malignancy.

When cancer does develop, the body tends to react with systemic inflammation, which increases ESR. Therefore, an ESR that is abnormally high can be an early indicator that cancer is present, especially if it is combined with unexplained weight loss, anaemia, or fever.

How is ESR Measured and Interpreted?

Although ESR is not a specific test, it can be quite useful if it can be implemented in a proper way. Also, knowing how it's measured and how to interpret the values is important for sound clinical decision-making.

The ESR Test Procedure – Step by Step

1. Blood Collection: A venous blood sample is taken and typically from the arm.

2. Mixing with Anticoagulant: The blood is added to a tall, narrow tube and mixed with an anticoagulant in order to avoid clotting.

3. Observation Time: The tube remains undisturbed for approximately an hour.

4. Sedimentation Reading: The intensity at which the red cells have settled is read in millimetres, and this is our required ESR.

5. Turnaround Time: In most of the labs, results are usually ready in 1–2 hours.

Normal ESR Ranges by Age & Gender

Normal ESR (Erythrocyte Sedimentation Rate) values vary based on age and gender. For men under 50 years old, a normal ESR ranges from 0 to 15 mm/hr, while for men over 50, it increases slightly to 0 to 20 mm/hr. In women under 50, the normal range is 0 to 20 mm/hr, and for women over 50, it can go up to 30 mm/hr due to hormonal and physiological changes with age. Children generally have lower ESR levels, with a normal range between 0 and 10 mm/hr.

High ESR in Cancer – What does it really mean?

In cancer patients, a high ESR may indicate:

• Active inflammation as a result of tumour activity
• Infection or secondary events
• Immune response to cancer cells

But ESR is not specific to cancer. It may rise in cases of arthritis, tuberculosis, anaemia, or pregnancy. So, an elevated ESR should be investigated further instead of being used as a diagnosis on its own.

ESR Levels in Different Types of Cancer

Various cancers affect ESR differently. In general, the more aggressive or disseminated the disease, the greater the level of ESR.

Breast, Lung, and GI Cancers

Malignant solid tumours like those of the breast, lung, and gastrointestinal tumours are likely to have a moderate to raised ESR, especially in late disease or with metastasis. Inflammatory processes around the tumour and lymphadenopathy can also result in raised values.

Blood Cancers (Leukaemia, Lymphoma, Myeloma)

Hematologic malignancies tend to produce markedly raised ESR, at times above 100 mm/hr. This results from the hyperproduction of neoplastic cells and proteins that alter blood viscosity and cell piling up (rouleaux formation).

In multiple myeloma, for example, ESR may be a critical marker for diagnosis and follow-up, since abnormal plasma proteins cause greatly enhanced sedimentation.

ESR Compared to Other Inflammatory or Tumour Markers

ESR is only one piece of a larger diagnostic puzzle. Knowing how it relates to other markers can enhance clinical results.

ESR Compared to CRP (C-Reactive Protein)

Both tests – ESR (Erythrocyte Sedimentation Rate) and CRP (C-Reactive Protein)- are blood tests that measure inflammation in the body, but they react and indicate different things. ESR indicates chronic (long-term) inflammation, due to the slow nature of the changes. It takes a while to rise and to return to normal, so it is good for monitoring active chronic inflammatory diseases, such as auto-immune diseases. 

Conversely, CRP is a more sensitive and specific marker of acute inflammation. Its levels rise rapidly, typically within 6 hours to 8 hours of inflammation, and revert to normal levels fast when the inflammation ends.

ESR vs Tumour Markers (CA-125, PSA, etc.)

Tumour markers such as CA-125 (ovarian), PSA (prostate), and CEA (colon) are proteins that are made by certain cancers. ESR, however, is non-specific but can find inflammation even when tumour markers are normal. Therefore, ESR is useful for monitoring on a regular basis, especially when tumour markers are inconclusive or not available. 

Role of ESR in Monitoring and Prognosis of Cancer

Aside from diagnosis, ESR is also useful for monitoring the progress of disease as well as the response to treatment.

Role of ESR in Chemotherapy & Post-Treatment

Intermittent ESR measurements in chemotherapy can detect:

• Response to chemotherapy
• Development of complications (e.g., infection)
• Relapse following remission

A declining ESR trend often reflects treatment success, while persistent elevation may warrant further investigation.  

Can ESR Predict Cancer Progression or Remission?

Some studies suggest ESR levels correlate with prognosis:

• High baseline ESR is often linked to poorer outcomes.
• Normalising ESR during treatment may indicate remission.

However, this is not universal and should not replace imaging or biopsy data.

Limitations of ESR in Cancer Diagnosis

While useful, ESR is far from perfect. There are important limitations to consider.

False Positives and Confounding Conditions

An elevated Erythrocyte Sedimentation Rate (ESR) is not specific to cancer. There are several other conditions that can raise ESR levels, including:

• Infections
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
• Chronic kidney disease
• Age-related changes

Hence, ESR should be interpreted in the context of clinical symptoms, medical history, and other test results.

When ESR Alone Isn’t Enough

No physician should solely depend on ESR to diagnose or treat cancer. It's not specific enough for precision medicine. Rather, it should be used with:

• Imaging (CT, PET scans)
• Biopsies
• Tumour markers
• Histopathological findings

When Should You See a Doctor About ESR Levels?

You should see a doctor if:

• Your ESR consistently rises
• You have symptoms such as unexplained weight loss, fatigue, night sweats, or fever that lasted more than a week
• You're receiving cancer treatment and notice sudden spikes in ESR

These presentations could reflect complications or disease advancement in need of early intervention.

Last Thoughts: What ESR Levels Reveal – and What They Don't

ESR is a useful, non-specific inflammatory marker that is often elevated in cancer patients. It cannot be used to diagnose cancer individually but should be utilized as part of a multi-step diagnostic workup. 

Utilized judiciously, ESR can aid in early detection, monitor response to treatment, and signal recurrence, providing both clinicians and patients with an economical, readily available tool along the cancer treatment path.