7-Tumor Markers

What is cancer

disease that starts with uncontrolled cell proliferation from 1 cell

What is ‘screening’? List examples.

Testing for cancer when no symptoms to allow for early diagnosis

Examples:

• breast exams

• mammograms

• fecal occult

• rectal exam

Why are tumor markers not useful for screening?

most tumor markers are found in normal cells (PSA comes closest to being specific)

What is a tumor marker?

produced by tumor and used to determine size and therapy response

What would make the best tumor marker?

1. Tumor specific

2. Absent in healthy ppl

3. readily detectable

4. free (unbound)

What uses do we tumor markers for?

• high risk pop screen

• staging/prognosis

• choosing treatments

• monitor therapy

• detect reoccuance

What characteristics does a blood tumor marker have?

• not specific for malignant tissues

• measurable in blood

• origin related to malignancy

• detect/monitor

• progression

Types of Tumor Markers

1. Glyco- or Muco- proteins from Adenocarcinoma

2. Tissue-specific proteins

3. Oncofetal proteins/antigens

4. Tumor-produced hormones

5. Enzymes

6. Propriety gene expression

Glyco or Muco proteins from Adenocarcinomas

Ex:

CA 125

CA 15-3 (CA 27.29)/CA 19-9

Tissue specific proteins

Ex:

Immunoglobulins

PSA; Thyroglobulin

Receptors (estrogen/progesterone, non serologic)

Oncofetal proteins/antigens

Ex

AFP

CEA

What are Oncofetal proteins/antigens

produced during fetal life and disappear but reappear in cancer

Tumor produced hormones

Ex

Enzymes

Ex

PSA

ALP

PSA is a serine____enzyme, what are the 2 major forms

protease

2 forms:

• free

• complexed

PSA is _____specific for prostate and related glands

nearly

Men with prostate cancer have_____circulating Free PSA

less

PSA is useful as a TM in pts with

prostate cancer

Free PSA and screening

CA-125 is a marker for

monitoring ovarian cancer therapy

CA-125 is useful in determining

prognosis of pts with endometrial carcinoma

What are monoclonal gammopathies

uncontrolled division of plasma cell leading to abnormal incr in monoclonal proteins (antibodies)

What diagnosis does it help make

multiple myeloma

The ____protein may be useful as a TM for monitoring disease

Bence-Jones

What is the Bence-Jones protein

immunoglobulin light chain (kappa or lambda) in urine

What is Bence-Jones protein famously known for

Multiple Myeloma

ß2-Microglobulin is a component of the _____molecule

class I

ß2-Microglobulin is on all ______cells

nucleated

ß2-Microglobulin has elevated ____ and used in the diagnosis of____

serum levels; Multiple Myeloma

High ß2-Microglobulin levels indicate a ______prognosis

poor

Thyroglobulin only produced in the ____gland

thyroid gland (follicles)

Thyroglobulin is elevated in ____or _____cancer

papillary or follicular thyroid

thyroglobulin main use is to

monitor pts being treated for thyroid cancer

If thyroglobulin is used for a tumor marker what should also be tested? why

anti-Tg since they can interfere with assay

CA 19-9 is used in monitoring what?

• pancreatic cancer

• hepatobiliary cancer

CA 19-9 can also be elevated with what issue

any bile duct obstruction

CA 19-9 is not used for staging but high levels do indicate what?

poor prognosis

CA 15-3 and CA 27-29; What type of patient uses these TMs?

women with metastatic breast cancer

CA 15-3 and CA 27-29: What are these TMs useful in monitoring?

course of disease

What are the main 3 things AFP is used for?

1. open neural defects in fetus

2. Hepatocellular carcinoma

3. testicular cancer

How is AFP used in the cancers?

• diagnosing, staging, prognosis, monitoring

• screen high risk populations (ethanol, hepatitis)

What type of protein is CEA?

Glycoprotein “Oncofetal protein”

CEA is the most widely used TM for what?

colorectal cancer

CEA can also be elevated in what?

• non-malignant conditions: smokers, COPD, alcohol, hepatitis

• lung, breast, GI cancer

How is CEA used?

prognosis, post surgery, response to chemo

What are the 3 cancers/diseases that HCG is used for?

1. ovarian

2. testicular

3. gestational trophoblastic

What are 65% of elevated ACTH patients seen with?

small cell carcinoma of lung “oat lung”

How does small cell carcinoma of the lung present on the patient?

Cushing syndrome: excess cortisol

What is the biomarker for prolactinoma?

Prolactin

What is the most common pituitary tumor?

Prolactinoma

Know TM with its cancer