From the Guidelines
An elevated Erythrocyte Sedimentation Rate (ESR) over 100 does not specifically indicate cancer. While a markedly elevated ESR (>100 mm/hr) can be concerning, it is a non-specific inflammatory marker that can be elevated in many conditions besides cancer, including severe infections, autoimmune disorders like rheumatoid arthritis or lupus, temporal arteritis, polymyalgia rheumatica, and certain kidney diseases 1. Cancer is just one of many possible causes. ESR measures how quickly red blood cells settle in a tube of blood, which increases when inflammatory proteins are present in the bloodstream.
Key Points to Consider
- When a patient presents with an ESR over 100, doctors typically conduct a thorough evaluation including a complete history, physical examination, and additional targeted tests based on the patient's symptoms and risk factors.
- The ESR should be interpreted in the clinical context rather than as a standalone diagnostic test for cancer.
- If you have an elevated ESR, it's essential to follow up with your healthcare provider to determine the underlying cause rather than assuming it indicates cancer.
Relevant Tests and Considerations
- A complete blood count (CBC) with differential can help identify other potential causes of an elevated ESR, such as bacterial infection or lymphoma 1.
- Other tests like antineutrophil antibody (ANA), anti-Ro/SSA, anti-La/SSB, and thyroid-stimulating hormone (TSH) can also be useful in evaluating the underlying cause of an elevated ESR.
- It's crucial to note that ancillary testing should not delay the workup of a possible malignancy, and a thorough evaluation should be conducted promptly 1.
From the Research
ESR and Cancer Indication
- An ESR over 100 does not necessarily indicate cancer, as elevated ESR can be caused by various conditions, including infections, autoimmune diseases, and inflammatory disorders 2, 3, 4.
- Studies have shown that the prevalence of malignancy in patients with elevated ESR is low, and elevation of ESR is not an early sign of malignant disease 2.
- A study found that among patients with ESR ≥ 100 mm/h, rheumatic diseases were a significant cause, in addition to malignancy and infections 4.
ESR Measurement and Inflammation
- ESR measurements can reflect inflammation, but the Westergren method may not be as accurate as other methods, such as TEST 1, in patients with malignancy, autoimmune disease, or infection 5.
- ESR and C-reactive protein (CRP) are markers of inflammatory conditions, and understanding their physiologic principles is important for appropriate use in clinical practice 6.
Clinical Interpretation of ESR
- An ESR of 70 mm or more can be a good index of morbidity, but it has low sensitivity and does not point to a specific disease 3.
- Extremely high ESR (≥ 100 mm/h) can be a valuable clinical parameter, and clinicians should consider other tests, such as serum albumin levels, platelet count, and ferritin, when evaluating patients with rheumatic diseases 4.