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MIDTERMS > CCHM TUMOR MARKERS > Flashcards

CCHM TUMOR MARKERS Flashcards

1
Q

Major Processes Involved in Cell Growth

A

Proliferation
Differentiation

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2
Q

Formation of solid mass or tumor
Activation of ___ eg. ___
Activation of ____ (___),
Inhibition of ____, ___ and ____ (eg___)

A

Tumorigenesis
- growth factors (e.g., epidermal growth factor [EGF])
- oncogenes e.g., K-ras
-apoptosis
- tumor suppressor
cell cycle regulation genes (e.g., BRCA1, p53, cyclins)

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3
Q

Involves the multiplication of cells in an organ or tissue, which may consequently have _____ in volume.
Serves a useful purpose and is controlled by ____
Elevation of tumor markers is _____.

A

Hyperplasia
-increased
- stimuli
- transient

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4
Q

Tumors remain at the primary site and present a smaller risk to the host
At this stage the patient stands a good chance of being successfully treated by the complete removal of the tumor.
Early detection is critical to ___ prevention in general to high risk families in particular
Well differentiated and composed of cells resembling the nature of normal cells from the tissue of origin of the ____.

A

Benign
- cancer
- neoplasm

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5
Q

Involves the possibility of normal cells undergoing cancerous proliferation
Pathologic hyperplasia
Unregulated and serves no purpose
Elevation of tumor markers will be a___ phenomenon if not treated

A

Neoplasia
- long lasting

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6
Q

Due to genetic instability of tumor cells.

A

Malignant

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7
Q

____ malignancy that begins in the skin or in tissues that line or cover internal organs

A

Carcinoma

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8
Q

malignancy that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue

A

Sarcoma

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9
Q

malignancy that begins in blood-forming tissue, such as the ___> causes too many abnormal blood cells to be made

A

Leukemia
- bone marrow

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10
Q

malignancies that begin in the cells of the immune system

A

Lymphoma and multiple myeloma

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11
Q

refers to the uncontrolled growth of cells that can develop into a solid mass or tumor and spread to other areas of the body

A

cancer

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12
Q

Cause of the most cancer deaths
Due to multiple genetic changes that result to uncontrolled proliferation
Multistep processes involving numerous tumor cell-host cell and cell-matrix interactions
___ at the primary site penetrate their adjacent surroundings (epithelial basement membrane and the interstitial stroma.)
> invade ____ or ____ to distant sites
> venous/capillary beds or solid tissue of a distant organ.
It is a ___ selective process.

A

Metastasis
- Tumor cells
- blood or lymphatic vessels
- highly

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13
Q

Controls both ___ and __
Orderly and specific transmission of growth-regulatory messages from outside the cell to the machinery controlling replication inside the cell nucleus.

A

Signal Transduction Pathway
cell cycle and apoptosis

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14
Q

It involves the passage of a cell through a complete round of ___.
It is one of the most important determining factors controlling cell proliferation.

A

Cell Cycle
- replication

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15
Q

In most mammalian cells, the cell cycle is composed of ____, ___, ____, and ___

A

four phases:
G1, S, G2, M or Mitosis, Go

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16
Q

defined as the interval between the conclusion of mitosis and start of DNA replication

A

G1

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17
Q

– interval during which the nuclear genome is replicated

A

s

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18
Q

interval between completion of DNA replication and the onset of mitosis.

A

G2

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19
Q

fifth phase – metabolic compartment of reversibly quiescent cells occupy

A

Go

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20
Q

Encoded by a separate category of genes  when mutated, will not only increase genetic instability but also ____ cellular evolution and the progression to ___.
___ is result from the absence of certain cell cycle controls
Defects in the cell cycle machinery may help cause ___.

A

Cell Cycle
- accelerate
- malignancy
- Tumors
- cancer

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21
Q

A programmed cell or physiologic death
It is a natural self-destruct system present in all cells
Failure of cells to undergo ____ may lead to cancer.
It is the natural process the body  replacement of cells and the deletion of damaged cells inherent to normal functioning of multicellular microorganism.

A

Apoptosis
- apoptotic cell death

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22
Q

It is a control mechanism for _____ and ___
Provides a way for the body to eliminate cells that have been produced in excess, that have developed improperly, or that have sustained genetic damage.

A

Apoptosis
tissue remodeling during growth development.

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23
Q

Apoptosis Markers: ____, ___, and ____
They can be both inducers and inhibitors of cell-death
These markers would have tremendous potential for ___, ____ and ___

A

p53 protein, Bcl 2, and Fas/Fas ligand
diagnosis,
prognosis
therapeutic application

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24
Q

New blood vessels are formed. Tumor growth and metastasis are _____.
It is critical, not only for the growth of solid tumors, but also for the shedding of cells from the primary tumor and the development of metastases at distant sites.
The new blood vessels embedded in a tumor provide a gateway for tumor cells to enter the circulation and to metastasize to distant sites

A

Angiogenesis
- angiogenesis-dependent

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25
Q

The degree of it is an initial primary tumor correlates with metastatic spread and survival rates in patients
Assessment may, therefore, prove valuable in selecting patients with ___for aggressive therapy.

A

Angiogenesis
- early breast carcinoma

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26
Q

Most well known angiogenic factors:
___, ___ and ___

A

Vascular endothelial growth factor (VEGF)
Acidic and basic fibroblast growth factor (aFGF and bFGF)
Transforming growth factor alpha (TGF-alpha)

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27
Q

These are specific class of transmembrane glycoprotein involved whenever cells are ____ and __
They regulate the migration of ___ to sites of inflammation or into lymphatic tissue

A

Adhesion
-moving
- interacting
- leukocytes

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28
Q

Increasing evidence has shown that the appearance of certain membrane molecules is related to metastatic potential or a sign of the conversion of normal to ___

A

Adhesion
- malignant cells.

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29
Q

Three classes of adhesions:
___, ___ and ___

A

Selectins
Integrins
Immunoglobulin family

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30
Q

Cancer Progression

A

Metastasis
Loss of cell adhesion proteins (e.g., β-catenin and E-cadherin)
Activation of angiogenesis genes (e.g., VEGF)

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31
Q

Cancer Progression

A

Activation of oncogenes
Upregulation of proteases
Deactivation of adhesion molecules
Stimulation of angiogenesis genes
Mutation of cell cycle and DNA repair genes
Loss of tumor suppressor genes
Growth factor dysregulation

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32
Q

Activation of oncogenes

A

Ras proteins

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33
Q

Upregulation of proteases

A

MMPs Matrix metalloproteinases

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34
Q

Deactivation of adhesion molecules

A

E-cadherin

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35
Q

Stimulation of angiogenesis genes

A

VEGF Vascular endothelial growth factor (VEGF)

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36
Q

Mutation of cell cycle and DNA repair genes

A

p53, BRCA1, Cyclins

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37
Q

Loss of tumor suppressor genes

A

pRb APC

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38
Q

Growth factor dysregulation

A

EGF Epidermal growth factor (
HER2/neu

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39
Q

Factors Considered in Cancer Severity

A

Tumor size
Histology
Regional lymph
Node involvement
Presence of metastasis

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40
Q

higher stages are indicative of significant spreading and severe systemic disease

A

Disease severity

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41
Q

proliferation and metastasis occur at the expense of normal organ processes  cause of morbidity and mortality

A

Disease Progression

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42
Q

Localized primary tumor

A

stage I

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43
Q

Invasion of primary tumor through epithelium and into blood vessels

A

stage II

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44
Q

Migration of tumor into regional lymph nodes

A

Stage III

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45
Q

Metastasis and invasion of tumor to distant tissues

A

stage IIII

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46
Q

Produced either directly by the tumor or as an effect of the tumor on healthy tissue (host)

A

Tumor Markers

47
Q

Tumor markers used to

A

Differentiate a tumor from normal tissue
Detect the presence of a tumor based on measurements in the blood or secretions

48
Q

such as ___ and ___, which are normally expressed during fetal development but do not occur normally in the tissues or sera of children and adults

A

oncofetal antigens
- AFP and CEA

49
Q

proteins occurring in epithelial cellls that become elevated in tissue and serum in adeno- and squamous cell carcinomas, such as the ____, ___ and ___

A

CA 19-9, CA 125, and CA 15-3 proteins

50
Q

β chain of human chorionic gonadotropin (β-hCG),

A

polypeptide hormones,

51
Q

such as the placental isoform of alkaline phosphatase, that become elevated in the serum of patients with specific tumors

A

specific enzymes

52
Q

None of the tumor markers discovered had sufficient specificity and sensitivity in the general population
It is not recommended for most tumor markers, especially in an asymptomatic population

A

Screening

53
Q

The screening of primary hepatoma in Asian countries is based on the measurement of ___

A

Alpha-Fetoprotein (AFP)
serum AFP

54
Q

First tumor marker recommended for screening for prostate cancer in men older than age of 50.
The purpose was to detect prostate cancer at early curable stages, when the tumor is still confined inside the organ.

A

Prostate-Specific Antigen (PSA) and Free PSA

55
Q

Two major forms of Prostate-Specific Antigen (PSA) and Free PSA

A

Free PSA and a PSA –alpha1- antichymotrypsin (PSA-ACT)
Free PSA percentage of free PSA to PSA-ACT

56
Q

Free PSA and a PSA –alpha1- antichymotrypsin (PSA-ACT)
Free PSA percentage of free PSA to PSA-ACT ratio may help differentiate _____ from __

A

benign prostate hyperplasia (BPH) from prostate cancer.

57
Q

Several familial cancers are associated with germline mutations in various genes.
The most prominent are genes for susceptibility to ___ and ___ such as ___ and __ are now available to screen these families for the identification of carriers.

A

Susceptibility Genes
breast and ovarian cancer,
such as BRCA1 and BRCA2

58
Q

One of the two most useful applications of tumor markers involves their use in monitoring the course during treatment of the cancer patient.
The measurement of serum tumor markers during treatment gives an indication of the effectiveness of the antitumor drug used and provides a guide for the selection of the most effective drug for each individual case.

A

Monitoring Treatment

59
Q

Monitoring tumor markers for the detection of the recurrence following the surgical removal of the tumor.
It is desirable to monitor the patient using a ___ test to detect recurrence as early as possible.
It should be noted that the appearance of the most circulating tumor markers have a lead time of several months __ prior to the stage at which many of the physical procedures can be used for the detection of the cancer.

A

Detection of Recurrence
- highly sensitive tumor marke
- (3-6 months)

60
Q

Determination is based on the assessment of tumor ____, which, in turn, determines how a patient should be treated.
- factors measured in the clinical laboratory also indicate risk and predict the length of a relapse-free, as well as overall, survival period at the time of the primary therapy.
High levels of serum tumor marker measured during diagnosis would indicate the presence of a ___ associated with a poor prognosis.

A

Prognosis
-aggressiveness
- malignant or metastatic tumor

61
Q

Detecting the phenotypes in the blood circulation corresponding to early mutations of a cancer allows the detection of early neoplasm at the curable stage.
It should be noted that several risk factors may lead to ___, which can be identified and eliminated with diet adjustment and lifestyle change
Measurement of all mutant phenotypes and risk factors in the circulation would help to identify individuals at risk for cancer or detect early tumors in benign state.

A

malignant or metastatic tumor
-tumorigenesis

62
Q

Previously, drugs used in chemotherapy were predominantly _____ that were considerably toxic and had limited efficacy.

A

Target Therapy
- DNA-active drugs

63
Q

Inhibition of tumor cell proliferation may also be effective by introducing agents (or genes) that turn off the signaling pathway or pathways that specifically drive proliferation within a given tumor or tumor type.

A

Target Therapy

64
Q

The prevailing new rationale is aimed at the development of ____ on the basis of characterized mechanisms of action.
The specific defect of the tumor identified by these new tumor markers should, therefore, lead to the design of more specific drugs, including antibodies and small molecules, which inhibit growth factor receptors tyrosine kinases.

A

Target Therapy
- target-selective “smart” drugs

65
Q

Most used method to measure tumor markers

A

Immunoassays

66
Q
  • determined by analyzing specimens spanning the reportable range
A

Linearity

67
Q

___ - antigen excess > analyte concentrations exceed the analytical range excessively

A

Hook Effect

68
Q

circulating antibodies against human or animal immunoglobulin reagents > HAMAs

A

Heterophile antibodies -

69
Q

Used to detect endocrine metabolites
Tumor markers – detect ____
Not subject to hook effect, lot-to-lot antibody variation and heterophile antibody

A

High Performance Liquid Chromatography
- catecholamine metabolites

70
Q

identified in tissue sections typically from a fine-needle aspirate or biopsy samples

A

Immunohistochemistry and Immunofluorescence

71
Q

___ incubated with tissue sections - detect the presence (or absence) of antigens using colorimetric or fluorescent secondary antibodies

A

Immunohistochemistry and Immunofluorescence
-Specific antibodies
-

72
Q

Enzyme Assays

A

PSA - prostate cancer immunoassay
ALP alkaline phosphatase (ALP)
LDH Lactate dehydrogenase (LDH)

73
Q

Biopsy indication
___ and ___

A

Screening
- AFP and PSA

74
Q

high levels indicative of dse.

A

Diagnosis
- Metanephrines
- HVA/VMA
Prolactin
- PTH
- Chromogranin A

75
Q

high levels asso w/ poor prognosis
receptor stat used for indication of chemotheraphy

A

Prognosis
- Beta2 microglobulin
- CA125
CEA
- LD
- Her-2/neu
ER
PR

76
Q

Monitor efficacy of chemotheraphy: residual dse after surgery

A

Monitoring treatment
-CA125
CEA
CA19-9
AFP
hCG
- PSA
-SPE

77
Q

Inc asso with relapse

A

CA15-3
CA125
CEA
AFP
hCG
PSA

78
Q

Enzyme tumor markers

A

Prostate specific antigen
Lactate dehydrogenase
Alkaline phosphatase
Neuron specific enolase

79
Q

Tumor marker: Prostate specific antigen

A

Tumor type Prostate cancer
Method Immunoassay
Specimen serum
Clinical utility Prostate cancer screening, therapy monitoring and recurrence.

80
Q

TM: LDH

A

Tumor type Hematologic malignancies
Method Enzyme assay
Specimen serum
Clinical utility Prognostic indicator, elevated nonspecifically in numerous cancer

81
Q

TM: ALP

A

Tumor type metastatic carcinoma of bone, hepatocellular carcinoma, osteosarcoma, lymphoma, leukemia
Method enzyme assay
Specimen serum
Clinical utility determination of liver yand bone involvement: nonspecific elevation in many bone- related and liver cancers

82
Q

TM: Neuron- specific enolase

A

Tumor type Neuroendocrine tumors
Method radio immunoasssay, immunohistochemistry
Specimen serum
Clinical utility prognostic indicator and monitoring dse progression for neuroendocrine tumors

83
Q

Serum protein tumor markers

A

Serum M proteins
serum free light chains
b2 microglobulin

84
Q

Serum M proteins

A

Tumor type plasma cell dyscrasias
Method serum protein electrophoresis/immunofixation electrophoresis
Specimen serum
Clinical utility dx, therapeutic monitoring of plasma malignancies

85
Q

serum free light chains

A

Tumor type plasma cell dyscrasias
Method immunoassay
Specimen serum
Clinical utility dx, therapeutic monitoring of plasma malignancies

86
Q

b2 microglobulin

A

Tumor type hematologic malignancies
Method immunoassay
Specimen serum
Clinical utility prognostic marker for lymphoproliferative disorders

87
Q

Endocrine tumor markers

A

ACTH adrenocorticotropic hormone
ADH antidiuretic hormone
C peptide
calcitonin
chromogranin a
cortisol
gastrin
GH growth hormoe
HVA homovalinic acid
5-HIAA hydroxyindoleacetic acid
Metanephrines (fractionated)
PTH
PRL
VMA

88
Q

ACTH adrenocorticotropic hormone

A

Tumor type pituitary adenoma, ectopic ACTH-producing tumor
Method immunoassay
Specimen serum
Clinical utility prognostic marker for lymphoproliferative disordersx of ectopic- ACTH-producing tumor

89
Q

ADH antidiuretic hormone

A

Tumor type posterior pituitary tumors
Method immunoassay
Specimen serum
Clinical utility DX of SIADH

90
Q

C peptide

A

Tumor type insulin secreting tumors
Method immunoassay, elisa
Specimen serum
Clinical utility DX of insulinoma

91
Q

calcitonin

A

Tumor type MTC and neuroendocrine tumors
Method immunoassay,
Specimen serum
Clinical utility screening response to therapy and monitoring recurrence of MTC

92
Q

chromogranin a

A

Tumor type Pheochromocytoma, neuroblastoma, carcinoid tumor, cmall cell lung cancer
Method elisa ria
Specimen serum
Clinical utility aids in dx of carcinoid tumors phepchromocytomas and neuroblastomas

93
Q

cortisol

A

Tumor type adrenal tumors
Method ia
Specimen serum/ urine
Clinical utility aids in dx of carcinoid tumors phepchromocytomas and neuroblastomas of cushing syndrome, adrenal adenoma

94
Q

Gastrin

A

Tumor type neuroendocrine tumor
Method ia
Specimen serum
Clinical utility zollinger ellison syndrome gastrinoma

95
Q

GH

A

Tumor type pituitary adenoma, ectopic GH-secreting tumors
Method ia
Specimen serum
Clinical utility dx and post monitoring of acromegaly

96
Q

HVA homovalinic acid

A

Tumor neuroblastoma, pheochromocytoma, paraganglioma
Method hplc
Specimen 24hr urine
Clinical utility dx of carcinoid tumors

97
Q

5-HIAA hydroxyindoleacetic acid

A

Tumor typecarcinoid tumors
Method hplc
Specimen 24hr urine
Clinical utility dx and screening of carcinoid tumors of pheochromocytoma

98
Q

Metanephrines (fractionated)

A

Tumor type neuroblastoma, pheochromocytoma, paraganglioma
Method hplc
Specimen 24hr urine
Clinical utility dx and screening of pheochromocytoma

99
Q

PTH

A

Tumor type parathyroid adenoma
Method ia
Specimen serum
Clinical utility dx and postsurgical monitoring of parathyroid adenoma

100
Q

VMA

A

Tumor type neuroblastoma, pheochromocytoma, paraganglioma
Method hplc
Specimen 24hr urine
Clinical utility dx and screening of pheochromocytomaF neuroblastoma

101
Q

nonseminomatous tumors

A

Germ cell tumor -
1. yolk sac tumor(endodermal sinus tumor)
AFP Increased
hCG No
2. cholirocarcinoma
AFP no
hCG inc
3. embronal carcinoma
AFP inc
hCG +/-
4. teratoma
AFP no
hCG No

102
Q

Seminoma

A

GCT NONE
AFP Not elevated in pure tumors
hCG +/-

103
Q

CHO and Cancer Ag tumor markers

A

CA19-9
CA15-3
CA27-29
CA-125

104
Q

CA19-9

A

Tumor type Gastrointestinal cancer and adenocarcinoma
Method Immunoassay
Specimen Serum
Clinical utility Monitoring pancreatic cancer

105
Q

CA15-3

A

Tumor type Metastatic breast cancer
Method Immunoassay
Specimen Serum
Clinical utility Response to therapy and detecting recurrence

106
Q

CA27-29

A

Tumor type Metastatic breast carcinoma
Method Immunoassay
Specimen Serum
Clinical utility Response to therapy and detecting recurrence

107
Q

CA-125

A

Tumor type ovarian cancer
Method Immunoassay
Specimen Serum
Clinical utility monitoring therapy

108
Q

Receptor tumor markers

A

Estrogen receptor
progesterone receptor
Her-2/neu
Epidermal growth factor receptor

109
Q

Estrogen receptor
progesterone receptor

A

Tumor type breast cancer
Method ihc
Specimen biopsy
Clinical utility hormonal therapy indicator

110
Q

Her-2/neu

A

Tumor type breast cancer
Method ihc, fish, elisa
Specimen biopsy
Clinical utility prognostic and hormonal therapy indicator

111
Q

Epidermal growth factor receptor

A

Tumor type head, neck, ovarian, cervical cancer
Method ihc
Specimen biopsy
Clinical utility prognostic indicator

112
Q

Most well known angiogenic factors:

A

Vascular endothelial growth factor (VEGF)
Acidic and basic fibroblast growth factor (aFGF and bFGF)
Transforming growth factor alpha (TGF-alpha)

113
Q

Most well known angiogenic factors:

A

Vascular endothelial growth factor (VEGF)
Acidic and basic fibroblast growth factor (aFGF and bFGF)
Transforming growth factor alpha (TGF-alpha)

MIDTERMS (21 decks)

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