Tumor Markers

Tumor marker (cancer marker, biomarker)

A substance present or produced by the tumor or the host

No (they cannot be done by themselves)

Are tumor markers diagnostic test?

tissue (biopsy)

What is the optimal specimen for testing for cancer biomarkers?

blood (serum)

What is the most common specimen for testing for tumor biomarkers?

screening, diagnosis, staging, prognosis, therapeutic, monitoring

What are some reasons for testing for cancer markers?

High sensitivity, high specificity, 100% accuracy, quantity correlates with burden, detectable at the early stage, short half-life, simple, cheap

What are we looking for in a good tumor marker?

tumor specific proteins

Markers produced by specific tumor cells

non-specific proteins

Markers produced by the host response factors to the presence of a tumor

increased production proteins

Markers normally found in the body but are expressed or secreted at a much higher rate by malignant cells

CA125, CEA

What tumor marker can be used to help diagnose lung cancer?

AFP

What tumor marker can help to diagnose liver cancer?

PSA

What tumor marker can help to diagnose prostate cancer?

AFP, HCG

What tumor marker can help to diagnose testicular cancer?

CA125, CEA, HER2

What tumor marker can help to diagnose breast cancer?

CEA

What tumor marker can help to diagnose stomach cancer?

CEA

What tumor marker can help to diagnose colon cancer?

CA125, CEA

What tumor marker can help to diagnose pancreatic cancer?

CA125, CEA

What tumor marker can help to diagnose ovaries cancer?

Alpha Fetoprotein (AFP)

Protein synthesized by the fetal liver, yolk sac, and GI tract that acts like albumin during fetal development that rapidly clears after birth?

hepatocellular carcinoma (1000+), NSGCT, teratocarcinoma, pancreatic, gastric, lung, colon

What are some malignancies with AFP elevated levels?

hepatitis, cirrhosis, pregnancy

What are some benign conditions with elevated levels of AFP?

therapeutic response to chemo/radiation, surveillance, used with other screening tests (like hCG)

AFP is a reliable marker for

open neural tube defect (spina bifida, anencephaly, fetal abnormality)

High levels of maternal serum alpha fetoprotein (MSAFP) during pregnancy is correlated with

chromosomal abnormality (down syndrome)

Low levels of MSAFP during pregnancy is correlated with

Multiple of Median (MoM)

Lab values of MSAFP are normalized to _____________ to assess for deviation

15-18 weeks (all the way up to 21 weeks)

When do you do MSAFP screening?

fetal sonogram

If a 2nd MSAFP is elevated at the 21 week point what is the next step?

CEA (carcinoembryonic antigen)

What protein is found in the fetal intestine, pancreas, and liver that rapidly clears after birth?

colon, gastric, pancreatic, thyroid, lung cancer, breast, ovarian, uterine

What malignancies are associated with elevated levels of CEA?

hepatitis, cirrhosis, hypothyroidism, PUD, IBD (UC/Crohns), smoke

What benign conditions are associated with elevated levels of CEA?

70-80%, 80-90%

What is the diagnostic sensitivity/specificity for CEA?

staging, prognosis, therapeutic monitoring, surveillance

CEA is a reliable marker for

Human chorionic gonadotropin (hCG)

A glycoprotein normally synthesized by the placenta in pregnancy peaks in the 1st trimester with both alpha and beta subunits

germ cell cancer, gestational trophoblastic disease, choriocarcinoma, hydatidiform molar pregnancy, gastric, colon, pancreatic, liver, breast, oat cell carcinoma of the lung

Elevated levels of hCG is associated with which malignancies?

pregnancy, marijuana use

Elevated levels of hCG is associated with which benign conditions?

Qualitative (yes/no pregnant)

What type of hCG do you run first?

Quantitative hCG (how far along)

If the qualitative hCG is elevated what are we running next?

diagnosis, staging, prognosis, monitor therapeutic response, surveillance

hCG is a reliable marker for

prostate specific antigen (PSA)

A glycoprotein that is specific to prostate tissue and is directly proportional to tumor volume

BPH, prostatitis, mechanical manipulation of the prostate

Which benign conditions result in an elevated PSA?

screening, staging, prognosis, therapeutic monitoring, surveillance

PSA is reliable for

2.5 ng/ml

Medical decision point of PSA

men 55-69 (if indicated do it queen), usually combined with rectal exam

Screening guidelines for PSA

Complexed (alpha1-antichymotrypsin and beta2-macroglobulin)

What form of PSA is predominant in the serum in BPH

Free + complexed

Total PSA is made up of

Cancer antigen 125 (CA)

What glycoprotein found in cells that line the pelvic organs and peritoneum

ovarian (1500+), endometrial, pancreatic, lung, breast, colon

What malignancies are associated with high CA 125 levels?

endometriosis, ovarian cyst, liver disease, menstruation, pregnancy

What benign conditions are associated with high levels of CA 125?

staging, prognosis, therapeutic monitoring, surveillance

CA 125 is a reliable marker for

other modalties (pelvic exam, transvaginal U/S), other markers

CA 125 is the most sensitive (85%) when combined with

CA 19-9

What is synthesized by normal pancreatic and biliary duct cells, gastric, colon, and salivary epithelial cells?

pancreatic, colon, gastric cancers

High levels of CA 19-9 is associated with which malignancies

pancreatitis, cirrhosis

High levels of CA 19-9 is associated with which benign conditions?

monitoring, prognosis

CA 19-9 is reliable for

Estrogen/progesterone receptor assay

What can measure the natural history and response to hormone manipulation of a BIOPSY to determine the optimal response to endocrine therapy?

ER/PR positive disease with response to hormone therapy

If our estrogen and progesterone receptor assay has a result greater than 1% this is correlated with

Not good fam

What is the prognosis for an ER negative tumor?

treatment plans

Steroid receptors in breast cancer help us determine

cervical cancer, penile cancer

HPV 16 and 18 are markers for

sexual activity before 20, multiple partners, exposure to DES, history of smoking/STD, your male partner gets around

Risk factors for cervical cancers