Cancer & Tumor Markers

Question 1

What is the clinical utility for Prostate Specific Antigen (PSA)?

Answer 1

Prostate Cancer (PC)

Question 2

What is the non-age related range for PC screening?

Answer 2

< 4 ng/mL

Question 3

When is a biopsy recommended for a PSA? [Hint: think of the range]

Answer 3

PSA ranging 4-9 ng/mL

Question 4

What is PSA density (PSAD)?

Answer 4

This is when you divide PSA by prostate volume

Question 5

If PSAD is increased, what would that mean?

Answer 5

That would mean the patient is a greater risk of having PC then BPH (PSA&raquo_space; BPH)

Question 6

What are the two common types (not all inclusive) of molecular forms of PSA?

Answer 6

free PSA (fPSA) [ranging from 30-40%]
complexed PSA (cPSA) [ranging from 50-70%]

Question 7

What is PSA velocity?

Answer 7

Refers to rate of increase in PSA levels over time

- Faster rate of rise could suggest PC

Question 8

How would cPSA affect PC?

Answer 8

If cPSA has a linear relationship, it would signify PC (cPSA increased, PC would be more at risk)

Question 9

How would fPSA affect PC?

Answer 9

If fPSA has an inverse relationship, it would signify PC

fPSA decreased, PC would be more at risk

Question 10

Which of the following is true regarding a PSA statement?

a. Slower rate of PSA velocity is suggestive of PC
b. PSA screening for PC is < 4 ng/mL
c. The majority of serum PSA is unbound to plasma proteins
d. A reduced PSA density is associated with PC

Answer 10

b. PSA screening for PC is < 4 ng/mL

Question 11

What is carcinoembryonic antigen (CEA) helpful for?

Answer 11

It's helpful for monitoring treatment in:
- Colon cancer
- Breast cancer
It's helpful for staging/prognosis in:
- Colon cancer

Question 12

What is cancer antigen 15-3 (CA 15-3) helpful for?

Answer 12

It’s helpful for staging/prognosis & monitoring treatment in:
- Breast cancer

Question 13

What is cancer antigen 27.29 (CA 27.29) helpful for?

Answer 13

It’s helpful for staging/prognosis & monitoring treatment in:
- Breast cancer

Question 14

What is cancer antigen 125 (CA 125) helpful for?

Answer 14

It is helpful for staging/prognosis & monitoring treatment in:
- Ovarian cancer

Question 15

What is human chronic gonadotropin (hCG) helpful for?

Answer 15

It is helpful for staging/prognosis, monitoring AND diagnosis in:
- Germ cell tumors (ovaries/testis)

Question 16

What is cancer antigen 19-9 (CA 19-9) helpful for?

Answer 16

It is helpful for staging/prognosis & monitoring treatment in:
- Pancreatic cancer

Question 17

What is alpha fetoprotein helpful for? HINT: two things

Answer 17

It is helpful for staging/prognosis, monitoring treatment  and diagnosis in:
- Hepatocellular carcinoma
- Testicular cancer
It is also helpful for screening in"
- Hepatocellular carcinoma

Question 18

What is Beta-2 Microglobulin (B2M) helpful for?

Answer 18

It is helpful for staging/prognosis, monitoring treatment in:
- Multiple myeloma

Question 19

Which of the following serum tumor markers are used to stage and monitor treatment in breast cancer?

a. CA 15-3 and CA 125
b. CA 15-3 and CA 27.29
c. CA 27.29 and CA 125
d. CA 27. 29 and CA 19-9

Answer 19

b. CA 15-3 and CA 27.29

Question 20

Which of the following is utilized in the diagnosis of germ cell tumors of the ovaries and testes?

a. CEA
b. B2M
c. CEA
d. hCG

Answer 20

d. hCG

Question 21

What is the clinical utility of estrogen (ER) and Progesterone (PR)?

Answer 21

Breast cancer

Question 22

What would be needed if ER and PR become positive in breast cancer?

Answer 22

Treatment would be needed, such as:

- tamoxifen

Question 23

What is the clinical utility of human epidermal growth factor receptor 2 (HER2)?

Answer 23

Breast cancer

Question 24

What would be needed if HER2 becomes positive?

Answer 24

Treatment would be needed, specifically anti-HER2 such as:

- trastuzumab

Question 25

What is the clinical utility of BCR-ABL?

Answer 25

Chronic myelogenous leukemia

Question 26

If BCR-ABL is positive, what would be needed?

Answer 26

Treatment would be needed, such as a TK inhibitor:

- imatinib

Question 27

Which of the following predicts the likelihood that breast cancer will respond to hormonal therapies?

a. HER2
b. EGFR
c. BCR-ABL
d. ER & PR

Answer 27

d. ER & PR

Question 28

What is the clinical utility for epidermal growth factor receptor (EGFR)?

Answer 28

Pulmonary Adenocarcinoma (PA)

Question 29

What would be needed if mutation occurs in response to EGFRs?

Answer 29

TK inhibitors would needed for treatment

- eroltinib

Question 30

What is the clinical utility for V-Ki-Ras2 Kirsten Rat Sarcoma Viral Oncogene Homolog (KRas)?

Answer 30

Colorectal cancer

Question 31

What would be needed if a wild-type (nonmutated) occurs in response to KRas?

Answer 31

anti-EGFR treatment would be needed

- cetuximab

Question 32

What is the clinical utility for V-Raf Murine Sarcoma Viral Oncogene Homolog B1 (BRAF)?

Answer 32

Melanoma

Question 33

What would be needed if mutation occurs in response to BRAF?

Answer 33

BRAF inhibitors would be needed, such as:

- vemurafenib

Question 34

Are BRAF inhibitors recommended for wild-type tumors (nonmutated tumors)?

Answer 34

No, they are not recommended

Question 35

What is the clinical utility for anaplastic lymphoma kinase (ALK)?

Answer 35

Pulmonary Adenocarcinoma (PA)

Question 36

If abnormal fusion protein (EML4-ALK) occurs in response to the ALK, what treatment would be needed?

Answer 36

ALK inhibitors would be needed, such as:

- crizotinib

Question 37

Which mutation predicts lung cancer responsiveness to therapy with erlotinib?

Answer 37

EGFR

Question 38

RS, is a 61 yo male, diagnosed with colorectal cancer. Genetic testing reveals a wild-type tumor. Which treatment would be recommended?

Answer 38

Cetuximab