From the Guidelines
For a patient with a history of breast cancer presenting with headache and tinnitus, essential laboratory work should include a complete blood count (CBC), comprehensive metabolic panel (CMP), calcium levels, and tumor markers such as CA 15-3 or CA 27.29. These tests help evaluate for potential metastatic disease, particularly to the brain or bone, which can manifest with neurological symptoms. Additional important tests include:
- Thyroid function tests, as thyroid abnormalities can occur with certain cancer treatments and cause similar symptoms.
- Inflammatory markers like ESR and CRP to assess for inflammatory processes.
- Coagulation studies to rule out hypercoagulable states associated with malignancy.
- Vitamin B12 and folate levels, as deficiencies can cause neurological symptoms and may be affected by cancer treatments. These tests are crucial because breast cancer can metastasize to the central nervous system, and headache with tinnitus could represent early signs of brain metastases or carcinomatous meningitis, as suggested by guidelines for diagnosis and treatment of leptomeningeal metastasis from solid tumors 1. Early detection through appropriate laboratory evaluation allows for prompt intervention and improved outcomes in cancer patients with new neurological symptoms. It is also important to consider the patient's history and symptoms, as recommended in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of patients with breast cancer 1. However, it's worth noting that routine blood tests, imaging studies, and tumor markers are not recommended for routine breast cancer surveillance, as stated in the American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting 1. Therefore, the choice of laboratory tests should be guided by the patient's clinical presentation and medical history.
From the Research
Lab Work Considerations
For a patient with a history of breast cancer presenting with headache and tinnitus, the following lab work should be considered:
- Complete Blood Count (CBC) to assess for any abnormalities in blood cell components, which may indicate an underlying condition such as infection, inflammation, or cancer 2
- Inflammatory biomarkers, such as C-reactive protein, to evaluate the patient's risk of breast cancer recurrence or progression 3
- Blood tests to check for any electrolyte imbalances or other metabolic disorders that may be contributing to the patient's symptoms
Imaging Studies
Imaging studies such as MRI or CT scans may be necessary to rule out any secondary causes of headache, such as metastatic disease or other intracranial abnormalities 4, 5
Other Diagnostic Tests
Other diagnostic tests, such as audiological evaluations, may be necessary to evaluate the patient's tinnitus and determine its underlying cause
Considerations for Breast Cancer Patients
For patients with a history of breast cancer, it is essential to consider the potential relationship between breast cancer and headache disorders, including migraine 6
- Patients with breast cancer may be at higher risk for certain types of headache disorders, such as migraine, and may require specialized evaluation and treatment 6