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Clinical Chemistry 2 (CC2) > (P) Lec 2: Tumor Markers (Part 1) > Flashcards

(P) Lec 2: Tumor Markers (Part 1) Flashcards

1
Q

Cancer is a general term to describe how many types of malignancies can affect how many tissue types?

Note: 2 numerical answers

A

200 malignancies for 50 tissue types

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2
Q

Cancer is referred to as uncontrolled cell growth which is also known as what?

A

Tumorigenesis (of cells)

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3
Q

Cancer may develop into a solid mass (tumor) and be spread to other areas of the body during what process?

A

Metastasis

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4
Q

TOF: Cancer is considered as the leading cause of mortality in underdeveloped countries

A

False (DEVELOPED)

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5
Q

TOF: Cancer is mainly caused by genetic mutations

A

True

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6
Q

Most cases of cancer nowadays are caused by what kind of mutations?

A

Acquired genetic

Note: Mutations may be acquired or genetic/inherited but cancer nowadays is described as “acquired genetic”

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7
Q

Some of the cancer mutations include the ff.:

  1. (Activation/Deactivation) of oncogenes
  2. Growth factor (regulation/dysregulation)
  3. Loss of the tumor (enhancer/suppressor) gene
  4. Mutation of the cell cycle and (DNA/RNA) repair genes
  5. (Activation/Deactivation) of adhesion molecules
  6. (Dormancy/Stimulation) of angiogenesis genes
  7. (Downregulation/Upregulation) of proteases
A
  1. Activation
  2. Dysregulation
  3. Suppressor
  4. DNA
  5. Activation
  6. Stimulation
  7. Upregulation
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8
Q

TOF: Mutations that may cause tumorigenesis are NOT THE SAME with the mutations that may cause metastasis

A

True (cannot be both at the same time)

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9
Q

Which among the factors does NOT determine cancer severity?

  1. Tumor size
  2. Histology
  3. Regional lymph node involvement
  4. Toxin secreted
  5. Metastasis
  6. Histologic assessment
A
  1. Toxin secreted

Note: Severity is determined by combining the factors above

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10
Q

In cases of solid tumors, they may be classified into what which correlates with the severity of the disease?

A

4 stages

Note: An increasing stage means that the disease is spreading (systemic)

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11
Q

Cancer stages are presented as a function of what in terms of regionality and to other surrounding tissues?

A

Function of invasion and spread

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12
Q

Cancer Staging Progression

The tumor is localized in the organ or tissue that it mainly affects

A

Stage I

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13
Q

Cancer Staging Progression

  • There is an invasion of the primary tumor through the epithelium and into the BVs
  • Once inside the BVs, it is assumed that it is now circulating within the blood
A

Stage II

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14
Q

Cancer Staging Progression

There is migration of the tumor cells into the regional lymph nodes

A

Stage III

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15
Q

Cancer Staging Progression

Stage III is also known as?

A

Lymph node involvement stage

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16
Q

Cancer Staging Progression

Involves the metastasis and invasion of tumor cells into distant tissue

A

Stage IV

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17
Q

These are either produced directly by the tumor or as an effect of the tumor on healthy tissues

A

Tumor Markers

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18
Q

What Makes an Ideal Tumor Marker?

Refers to the quality of only being produced by the specific organ that is affected by the tumor

A

Tumor-specific

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19
Q

What Makes an Ideal Tumor Marker?

Refers to the quality of being easily distinguishable between an affected and unaffected individual

A

Absent in healthy individuals

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20
Q

What Makes an Ideal Tumor Marker?

Refers to the quality of being detected as early as possible

A

Elevated at an early stage

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21
Q

What Makes an Ideal Tumor Marker?

Refers to the quality of being detected in any specimen

A

Readily detectable in body fluids

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22
Q

TOF: As of now, there is still no ideal tumor marker that fits all the criteria

A

True

Note: Markers can be used alongside signs and symptoms as well as histology in order to produce a diagnosis

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23
Q

What happens to normal cells when they proliferate and/or dedifferentiate?

A

They become cancer cells

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24
Q

Give the specific tumor marker

These (2) reflect increased cellular proliferation

A

HER2 and Prostate-specific Antigen (PSA)

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25
Q

Give the specific tumor marker

This represents the dedifferentiation process of cancer

A

Carcinoembryonic Antigen (CEA)

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26
Q

Give the specific tumor marker

These (2) focus on collective changes in malignant cells

A

Genomics and Proteomics

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27
Q

Types of Tumor Markers

Includes Beta-2 Microglobulin and Immunoglobulins which are used for therapy purposes

A

Serum Proteins

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28
Q

Serum Protein Markers

This is a non-specific tumor marker present on the surface of all nucleated cells which makes the specific cell indistinguishable

A

Beta-2 Microglobulin

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29
Q

Serum Protein Markers

These are mostly used for hematologic malignancies

A

Immunoglobulins

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30
Q

Types of Tumor Markers

  • The first class of tumor markers to be discovered
  • Includes the carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP)
A

Oncofetal Antigens

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31
Q

Types of Tumor Markers

These are specific markers of secreting tumors

A

Hormones

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32
Q

Types of Tumor Markers

These are specific markers of secreting tumors which are commonly found in urine

A

Metabolites

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33
Q

Types of Tumor Markers

  • These are useful in classifying tumors in therapy
  • Includes Estrogen Receptor/Progesterone Receptor (ERPR)
A

Receptors

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34
Q

Receptor Markers

This receptor is known to be a serologic marker which immediately warrants a specific therapy once a solid tumor malignancy is found

A

Estrogen Receptor/Progesterone Receptor (ERPR)

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35
Q

Types of Tumor Markers

  • Comes from the metabolic demands of high-proliferative cells
  • Also used to monitor the success of a therapy
  • Are usually seen in serum specimens
A

Enzymes

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36
Q

Identify the Enzyme Tumor Marker

  • Tumor type: Prostate cancer
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Prostate CA screening, therapy, monitoring, and recurrence
A

Prostate-specific Antigen (PSA)

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37
Q

Identify the Enzyme Tumor Marker

  • Tumor type: Hematologic malignancy
  • Method: Enzyme assay
  • Specimen: Serum
  • Clinical utility: Prognostic indicator; elevated nonspecifically in numerous cancers
A

Lactate Dehydrogenase (LD)

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38
Q

Identify the Enzyme Tumor Marker

  • Tumor type: Metastatic carcinoma of bone, hepatocellular carcinoma, osteosarcoma, lymphoma, and leukemia
  • Method: Enzyme assay
  • Specimen: Serum
  • Clinical utility: Determination of liver and bone involvement; nonspecific elevation in many bone-related and liver cancers
A

Alkaline Phosphatase (ALP)

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39
Q

Identify the Enzyme Tumor Marker

  • Tumor type: Neuroendocrine tumors
  • Method: Radioimmunoassay and Immunohistochemistry
  • Specimen: Serum
  • Clinical utility: Prognostic indicator and monitoring disease progression for neuroendocrine tumors
A

Neuron-specific Enolase

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40
Q

Identify the Serum Protein Tumor Marker

  • Tumor type: Plasma cell dyscrasia
  • Method: Serum protein electrophoresis or Immunofixation electrophoresis
  • Specimen: Serum
  • Clinical utility: Diagnosis and therapeutic monitoring of plasma cell malignancies
A

Serum M-protein

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41
Q

Identify the Serum Protein Tumor Marker

  • Tumor type: Plasma cell dyscrasia
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis and therapeutic monitoring of plasma cell malignancies
A

Serum Free Light Chains

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42
Q

Identify the Serum Protein Tumor Marker

  • Tumor type: Hematologic malignancies
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Prognostic marker for lymphoproliferative disorders
A

Beta-2 Microglobulin

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43
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Neuroblastoma, pheochromocytoma, and paraganglionoma
  • Method: HPLC
  • Specimen: 24H urine
  • Clinical utility: Diagnosis of neuroblastoma
A

Homovanillic Acid (HVA) and Vanillylmandelic Acid (VMA)

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44
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Neuroblastoma, pheochromocytoma, and paraganglionoma
  • Method: HPLC
  • Specimen: 24H urine
  • Clinical utility: Screening and diagnosis of pheochromocytoma
A

Metanephrines (fractionated)

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45
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Neuroblastoma, pheochromocytoma, and paraganglionoma
  • Method: HPLC and LC-MS/MS
  • Specimen: 24H urine
  • Clinical utility: Screening and diagnosis of pheochromocytoma, paraganglionoma, and neuroblastoma
A

Catecholamines (fractionated)

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46
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Carcinoid tumors
  • Method: HPLC
  • Specimen: 24H urine
  • Clinical utility: Diagnosis of carcinoid tumors
A

Hydroxyindoleacetic acid (5-HIAA)

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47
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Carcinoid tumors
  • Method: HPLC
  • Specimen: Serum
  • Clinical utility: Diagnosis of carcinoid tumors
A

Serotonin

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48
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Medullary thyroid cancer (MTC) and neuroendocrine tumors
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Screening response to therapy and monitoring for the recurrence of MTC
A

Calcitonin

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49
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Parathyroid adenoma
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis and postsurgical monitoring of primary hyperparathyroidism
A

Parathyroid hormone (PTH)

50
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Pituitary adenoma, ectopic growth hormone-secreting tumor
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis and post-monitoring of acromegaly
A

Growth Hormone (GH)

51
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Pituitary adenoma
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis and post-surgical monitoring of prolactinoma
A

Prolactin (PRL)

52
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Pituitary adenoma and ectopic adrenocorticotropic hormone-producing tumor
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis of an ectopic adrenocorticotropic hormone-producing tumor
A

Adrenocorticotropic Hormone (ACTH)

53
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Adrenal tumors
  • Method: Immunoassay
  • Specimen: Serum or urine
  • Clinical utility: Diagnosis of Cushing’s syndrome and adrenal adenoma
54
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Posterior pituitary tumors
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)
A

Antidiuretic Hormone (ADH)

55
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Pheochromocytoma, neuroblastoma, carcinoid tumors, and small cell lung cancer
  • Method: ELISA or RIA
  • Specimen: Serum
  • Clinical utility: Diagnosis of carcinoid tumors, pheochromocytomas, and neuroblastomas
A

Chromogranin A

56
Q

Identify the Endocrine Tumor Marker

  • Tumor type: Insulin-secreting tumors
  • Method: ELISA or Immunoassay
  • Specimen: Serum
  • Clinical utility: Diagnosis of insulinoma
57
Q

Identify the Endocrine Tumor Marker

This detects the presence of Zollinger-Ellison Syndrome

58
Q

Endocrine tumor markers include what 2 types of tumor markers?

A

Hormones and Metabolites

59
Q

In endocrine tumor markers, are the ff. hormones or metabolites?

HVA, VMA, catecholamines, metanephrines, and 5-HIAA

A

Metabolites

60
Q

In endocrine tumor markers, the rest of the markers are hormones except for this by-product of insulin production

61
Q

Metabolites require what specimen for testing and what method?

Note: 2 answers

A

Specimen: 24H urine
Method: HPLC

62
Q

This is a disease due to an excess in the production of the growth hormone

A

Acromegaly

63
Q

Identify the Carbohydrate and CA Antigen Tumor Marker

  • Tumor type: GI cancer and adenocarcinoma
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Monitoring of pancreatic cancer
64
Q

Identify the Carbohydrate and CA Antigen Tumor Marker

  • Tumor type: Metastatic breast cancer
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Response to therapy and detecting recurrence
65
Q

Identify the Carbohydrate and CA Antigen Tumor Marker

  • Tumor type: Metastatic breast carcinoma
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: Response to therapy and detecting recurrence
66
Q

Identify the Carbohydrate and CA Antigen Tumor Marker

  • Tumor type: Ovarian cancer
  • Method: Immunoassay
  • Specimen: Serum
  • Clinical utility: For monitoring therapy
67
Q

Identify the Receptor Tumor Marker

  • Tumor type: Breast cancer
  • Method: IHC
  • Specimen: Biopsy
  • Clinical utility: Hormonal therapy indicator
A

Estrogen Receptor and Progesterone Receptor (ER/PR)

68
Q

Identify the Receptor Tumor Marker

  • Tumor type: Breast, ovarian, and GI tumors
  • Method: IHC, FISH, and ELISA
  • Specimen: Biopsy
  • Clinical utility: Prognostic and hormonal therapy indicator
69
Q

Identify the Receptor Tumor Marker

  • Tumor type: Head, neck, ovarian, and cervical cancers
  • Method: IHC
  • Specimen: Biopsy
  • Clinical utility: Prognostic indicator
A

Epidermal growth factor receptor

70
Q

Receptor Tumor Markers

This is the specimen of choice since these markers are present in the cells which make up the tissues

71
Q

Oncofetal Antigens

Alpha fetoprotein (AFP) is commonly measured together with this to determine the type of cancer, whether it is seminomatous or non-seminomatous testicular cancer

72
Q

Is it seminomatous or non-seminomatous?

Embryonal cancer, teratoma, choriocarcinoma, and yolk sac tumor

A

Non-seminomatous

73
Q

Is it seminomatous or non-seminomatous?

Seminoma

A

Seminomatous (it is the ONLY one)

74
Q

Identify the Oncofetal Antigen Marker

AFP: Increased
hCG: Not increased

A

Yolk sac tumor

75
Q

Identify the Oncofetal Antigen Marker

AFP: Not increased
hCG: Increased

A

Choriocarcinoma

76
Q

Identify the Oncofetal Antigen Marker

AFP: Increased
hCG: (+/-)

A

Embryonal CA

77
Q

Identify the Oncofetal Antigen Marker

AFP: Not increased
hCG: Not increased

78
Q

Identify the Oncofetal Antigen Marker

AFP: Not elevated in pure tumors
hCG: (+/-)

79
Q

Uses/Applications of Tumor Markers

  • Uses PSA and AFP
  • A biopsy indicator involving histotechniques
80
Q

Uses/Applications of Tumor Markers

  • Uses metanephrines, HVA/VMA, prolactin, PTH, chromogranin A, cortisol, and ACTH
  • High levels are indicative of a disease
81
Q

Uses/Applications of Tumor Markers

  • Uses B2-microglobulin, CA-125, CEA, LDH, Her-2/neu, ER, and PR
  • Receptor status is used as an indication of chemotherapy
82
Q

Uses/Applications of Tumor Markers

TOF: Tumor marker concentration increases with tumor progression, the higher the stage of the tumor, the higher chance of metastasis

83
Q

Uses/Applications of Tumor Markers

  • Uses CA-125, CA 19-9, CEA, AFP, hCG, PSA, and SPE
  • Observes the efficacy of chemotherapy or residual diseases post-surgery
A

Monitoring treatment

84
Q

Uses/Applications of Tumor Markers

TOF: Tumor markers are only useful in determining a prognosis

A

False (can also determine whether a specific therapy is effective or not)

85
Q

Uses/Applications of Tumor Markers

TOF: Markers are only measured before a patient has undergone therapy

A

False (after as well)

86
Q

Uses/Applications of Tumor Markers

Initially, there is a/an (increased/decreased) tumor marker at diagnosis

87
Q

Uses/Applications of Tumor Markers

  • Uses CA-15-3, CA-125, CEA, AFP, hCG, and PSA
  • There is an increased association with relapse
A

Detection of recurrence

88
Q

The possibility of cancer recurrence is taken into account when a patient experiences the same set of what that they have already experienced before?

89
Q

Lab Considerations for Tumor Marker Measurement

There is a wide range of ________ in tumor markers by orders of magnitude

A

Concentrations (hence why tumor markers are difficult to measure in different samples)

90
Q

Lab Considerations for Tumor Marker Measurement

There is ________ of the tumor marker concentration between different manufacturers due to a lack of harmonization and standardization

A

Variability

91
Q

Methods of Detection

  • The most commonly used method to measure tumor markers
  • Markers are detected using capture and label antibodies
A

Immunoassays

92
Q

Methods of Detection

When analyte concentrations exceed the analytical range excessively, both capture and label antibodies are saturated leading to a lack of sandwich formation (decreased signal), what is this event called?

A

Hook Effect

93
Q

Methods of Detection

  • This refers to the shape of the concentration-signal curve when reagents are saturated with excess antigen
  • Can result in falsely low measurements
A

Hook Effect

94
Q

Methods of Detection

This is done to prevent the hook effect from happening

A

Dilution techniques

95
Q

Methods of Detection

A disadvantage of the Immunoassay technique wherein there are excessively high levels of markers that can result in excess antigen

A

Hook Effect

96
Q

Methods of Detection

A disadvantage of the Immunoassay technique wherein the presence of heterophile antibodies (e.g. human anti-animal antibodies [HAAA] and human anti-mouse antibodies [HAMAs]) can result in false positives and negatives

A

Interference

97
Q

Methods of Detection

TOF: The immunoassay technque is not affected by icteric, lipemic, and hemolyzed samples and antibody cross reactivity

A

False (is affected)

98
Q

Methods of Detection

Lipemic samples will only be accepted using the Immunoassay technique if the patient is sufffering from what 2 conditions?

A
  1. Hyperlipoproteinemia
  2. Liver damage
99
Q

Methods of Detection

  • Used to detect small molecules (e.g. endocrine metabolites) and catecholamines in plasma and urine
100
Q

Methods of Detection

In HPLC, catecholamines and their metabolites are used for the diagnosis of what 3 conditions?

A
  1. Neuroblastoma (epinephrine, norepinephrine, and dopamine)
  2. Pheochromocytoma (metanephrines)
  3. Carcinoid tumors (5-HIAA)
101
Q

Methods of Detection

TOF: HPLC does not produce any linearity/hook effect

102
Q

Methods of Detection

  • Used for the detection of tumor markers directly within solid tissues
  • Similar to immunoassays but a specific cell type is determined
  • e.g. ERPR is used for breast cancer detection
A

Immunohistocytochemistry

103
Q

Methods of Detection

  • These are released from cells when necrosed or have underwent changes in permeability
  • However, this cannot be used to identify a specific tumor or site of tumor
A

Enzyme Detection

104
Q

Commonly Requested Tumor Markers

  • A major fetal serum protein and major carcinoembryonic protein
  • Elevated in primary hepatocellular carcinoma (HCC) and germ cell tumors, specifically testicular cancer
  • Also elevated in pregnancy and benign liver diseases
A

Alpha Fetoprotein (AFP)

105
Q

Commonly Requested Tumor Markers

TOF: Low levels of AFP in hepatocellular carcinoma = poor progonisis

A

False (high levels)

106
Q

Commonly Requested Tumor Markers

  • A mucin protein
  • Detects ovarian tumors at an early stage
  • The only clinically accepted serologic marker for ovarian cancer
  • Also elevated in endometriosis (myoma), 1st trimester of pregnancy, and during menstruation
A

Cancer Antigen 125 (CA-125)

107
Q

Commonly Requested Tumor Markers

Aside from CA-125, this can also be used for ovarian CA diagnosis as it is less frequently increased in non-malignant conditions (e.g. endometriosis)

A

Human Epididymis Protein (HE4)

Note: An increased CA-125 and HE4 is very evident for ovarian CA

108
Q

Commonly Requested Tumor Markers

  • The most widely used marker for colorectal cancer
  • Also elevated in lung, breast, and GI tumors and in impaired clearance
  • Associated with cell adhesions
  • Is NOT USED FOR SCREENING as it is sometimes regarded as non-specific for colon cancer
A

Carcinoembryonic Antigen (CEA)

109
Q

Commonly Requested Tumor Markers

TOF: All instances of increased CEA levels point to cancer

A

False (it can also be increased when clearance is impaired)

110
Q

Commonly Requested Tumor Markers

  • A hormone normally secreted by trophoblasts of the placenta to maintain the corpus luteum during pregnancy
  • Is elevated in trophoblastic tumors, choriocarcinoma, ovarian, and testicular tumors (psammomatous or non-psammomatous)
  • Used for the detection of gestational trophoblastic diseases or hydatidiform moles
A

Human Chorionic Gondatotropin (hCG)

111
Q

Commonly Requested Tumor Markers

This type of hCG is sensitive and specific for aggresive neoplasms

A

Beta-hCG (not alpha or total hCG)

112
Q

Commonly Requested Tumor Markers

Beta-hCG has 2 subunits which are?

A

Intact and Free

113
Q

Commonly Requested Tumor Markers

  • Are serine proteases that regulate the viscosity of the seminal fluid
  • It aids in dissolving the cervical mucus cap to allow the penetration of sperm
  • Is measured via immunoassay to detect prostate cancer, infection, irritation, and benign prostatic hyperplasia
A

Prostate-specific Antigen (PSA)

114
Q

Commonly Requested Tumor Markers

This form of PSA is present in the serum

115
Q

Commonly Requested Tumor Markers

This form of PSA is bound to alpha 1-antichymotrypsin and alpha 2-macroglobulin

A

Complexed form

116
Q

Commonly Requested Tumor Markers

TOF: When measuring PSA via immunoassays, it is able to detect those that are bound to alpha 2-macroglobulin

A

False (alpha 1-antichymotrypsin)

Note: PSA complexed with A2-macroglobulin is not detectable

117
Q

Commonly Requested Tumor Markers

A (high/low) level of the free form of PSA correlates with malignancy

118
Q

Commonly Requested Tumor Markers

Screening for prostate cancer is ideally done at what age?

A

> 50 years old

119
Q

Commonly Requested Tumor Markers

What level of PSA is considered normal?

120
Q

Commonly Requested Tumor Markers

TOF: AFP can only be detected in pregnancy and tumors related to the reproductive system

A

False (can also be found in liver diseases)

Clinical Chemistry 2 (CC2) (12 decks)

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