Elevated NSE Levels: Anxiety, Inflammation, or Cancer Risk?

The NSE index is too high?

Hello, doctor.
I recently went to a medical laboratory for cancer screening, and one of the tests showed an elevated NSE level of 22.39.
My family has no history of lung cancer, and I asked the laboratory technician about this.
He mentioned that it could be caused by a cold, excessive stress, anxiety, or immune system dysregulation leading to neuroinflammation.

Here are the reasons for my anxiety: Three weeks ago, I accidentally felt a lump in my submandibular lymph nodes (it was not visible on the surface and could only be felt by touch).
At that time, I thought it was a cold and visited an ENT clinic.
The doctor diagnosed me with mild tonsillitis and prescribed medication for one week, but the lymph nodes did not reduce in size after finishing the medication.
In the second week, I went to see a traditional Chinese medicine practitioner, who also prescribed cold medication, but again, there was no reduction in swelling.

In the third week, I visited the ENT department at a major hospital, where the doctor performed a physical examination and mentioned that medication might not be effective.
He advised me to get an ultrasound, and further diagnosis would follow once the report was available (this will be after the New Year).
The more articles I read online, the more worried I became about having a serious illness.
During this period, I experienced severe insomnia, sometimes unable to sleep all night, other times waking up after three hours and unable to fall back asleep, or having fragmented sleep.
On days when I couldn't sleep at all, my appetite significantly decreased.
Eventually, I consulted a psychiatrist, who prescribed medication to help me sleep better.
I would like to ask if stress, anxiety, and immune system dysregulation can cause abnormal NSE levels, or is there a higher possibility that it indicates cancer? P.S.
Last August, I had a chest X-ray due to suspected fishbone obstruction and slight chest pain, and I consulted both ENT and thoracic surgery specialists, who found no abnormalities.
I also underwent an endoscopy, which revealed mild gastroesophageal reflux.

Niming, 20~29 year old female. Ask Date: 2018/02/09

Dr. Hu Ziren reply Oncology

Currently, NSE cannot be used for cancer screening or monitoring.
However, if you are a smoker, it is recommended to have a follow-up test in three months.
If the levels continue to rise, it is advisable to consult a pulmonologist or a hematologist for further evaluation.

Reply Date: 2018/02/09

More Info

Elevated levels of neuron-specific enolase (NSE) can indeed raise concerns about potential underlying health issues, including cancer. However, it is essential to understand that NSE is not a definitive marker for cancer diagnosis. Instead, it is more commonly associated with neuroendocrine tumors, particularly small cell lung cancer, and can also be elevated in other conditions such as neurological disorders, inflammation, and even stress-related responses.

In your case, with an NSE level of 22.39, which is slightly below the typical threshold of 23.5, it is crucial to consider the context of your overall health and any accompanying symptoms. The medical professional you consulted mentioned that elevated NSE levels could be linked to factors such as anxiety, immune system dysregulation, or even recent infections like a cold. This is a valid point, as stress and anxiety can lead to physiological changes in the body, including inflammation, which may contribute to elevated NSE levels.

Your recent experiences with anxiety, sleep disturbances, and the palpable lymph node swelling in your neck are significant. Anxiety can trigger a cascade of physiological responses, including the release of stress hormones, which may affect immune function and potentially lead to inflammatory responses. This inflammation could, in turn, influence NSE levels. Additionally, the presence of a swollen lymph node may indicate an immune response to an infection or other benign conditions, rather than malignancy.

It is also worth noting that while family history can play a role in cancer risk, the absence of lung cancer in your family history is a reassuring factor. However, it does not entirely eliminate the possibility of cancer, especially considering your elevated NSE levels. The best course of action is to follow up with your healthcare provider for further evaluation, including imaging studies or additional blood tests, to rule out any serious conditions.

In summary, while elevated NSE levels can be concerning, they are not solely indicative of cancer. Factors such as anxiety, inflammation, and immune responses can also contribute to elevated levels. It is essential to approach this situation holistically, considering both your physical health and mental well-being. Regular follow-ups with your healthcare provider, along with appropriate diagnostic tests, will help clarify the situation and guide you toward the best management plan. If anxiety is significantly impacting your quality of life, seeking support from mental health professionals can also be beneficial.

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