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Pathology > Tumor Marker > Flashcards

Tumor Marker Flashcards

1
Q

Prognostic-

Predictive-

A
  • predicting survival rate

- predict rxn to therapies

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2
Q

Serum proteins-

A

Nonspecific malig, indicate infl

Acute- CHAB (c-reactive protein, haptoglobin, alpha 2 macro, beta 2 micro)
Chronic- hyperbilirubinemia

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3
Q

Ectopic H

A

Travel in blood, could be paraneoplastic

PTH, GH, ACTH, TSH, HCG-beta

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4
Q

Hormone receptors

A

On cell surface, in cytoplasm-> can change cell behavior

Estrogen, progesterone( breast cancer)

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5
Q

Oncofetal antigen

A

CEA-> not sen spi early cancers

Alpha- feto protein

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6
Q

CEA

Produced by mucin secreting glandular epithelium

A

Useful w- colorectal, pancreatic, lung, gastric, breast

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7
Q

CEA

Benign situations

A

HIS AC

Smoking, IBD, Alcoholoc Cirrhosis, hepatitis

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8
Q

Alpha feto protein->Screen high risk popul

Made by:

A

Made by yolk sac, fetal liver, fetal GI, little in adult liver

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9
Q

Alpha feto protein

Useful w:

A

Liver, germ cells(testis), dec w lung, colon, pancreas

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10
Q

Alpha feto protein

Benign situ:

A

Liver- cirr,necr,hepa
Pregnancy,
Neural tube defects

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11
Q

ALP

A
  • building bone(osteoblastic)

- effects bone, liver, placenta, intestine, regan

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12
Q

ALP

Benign sit:

A

Pregnancy, childhood, obstructive liver ds, hepatitis, pagets, fracturer

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13
Q

Breast

A

CEA, CA-27-29, CA-15-3

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14
Q

Tumor markers: produced by

A

Mal + benign

Inc ds state
Inc spec sen

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15
Q

Acid phosphatase

A
  • breaking bone (osteoclasts)

- effects bone, prostate, erythrocyte, platelets

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16
Q

Acid phosphatase

Benign sit:

A

BPH, mech trauma

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17
Q

PSA (prostate specific antigen)

Made by prostate (B or M)
Small amt- normal

A

Inc level= inc tumor size; advanced

->BPH, inflam, trauma

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18
Q

Best to ID recurrence

A

PSA

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19
Q

PSA

Treatment

A

> 4ng/ml= biopsy, but

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20
Q

CA 125

Useful w

A

Pancreatic, endometrial, ovarian

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21
Q

CA125

Benign w

A

POUR End

Pregnancy, ovarian cysts, uterine, recurrence monitor, endometriosis

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22
Q

CA 15-3

Useful w

A

Breast LEGO

Advanced breast, lung, endomet, GI, ovary

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23
Q

CA 15-3

Benign w

A

Pets help

Pregnancy, TB, sarcoidosis
Hepatitis, endometriosis, lupus, pelvic inflam

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24
Q

CA 27-29

Useful w

Only renal

A

Breast, colon, hepatitis, Group

Breast, colon, hepatitis
Gastric, renal, ovarian, uterine, pancreas

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25
Q

CA 19-9

Useful w

A

Colon, pancreas, biliary

Good for monitoring therapy in advanced cancer

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26
Q

Lung

A

CEA, CA 27-29, CA 15-3, alpha feto

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27
Q

Liver

A

Alpha feto, CA 27-29, CA 19-9

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28
Q

GI

A

CEA, CA 27-29, CA 15-3

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29
Q

Tumor Markers

A

• produced by malignant cells or by benign cells in response to the presence of malignancy
• May be applied to the detection, identification, monitoring, radiolocation, and therapy of malignancies

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30
Q

Where Found

A

• May be found in body fluids, tissue, or tissue extracts

31
Q

General Principles

A

• Sensitivity and specificity of tumor markers typically improves in advanced disease
• Few are applicable for screening high risk groups
• Not yet useful in screening the general population

32
Q

Use of Tumor Markers

A
  • Detection
    • Confirmation and diagnosis
    • Detecting recurrence or metastasis
  • Monitoring response to therapy
    • Aid in choice of therapy
33
Q

Use of Tumor Markers

Prognostic markers:

A

• Prognostic markers:
– Generally used to describe molecular markers that predict disease-free survival, disease specific survival, and overall survival
• Predictive markers:
– Used in the context of predicting response to certain therapies
• Often used interchangeably

34
Q

Important Facts to Know

A

• Typically, should not rely on the result of a single test
• When ordering serial tests—use the same lab
• Be sure the marker you are studying was elevated prior to surgery

35
Q

Important Facts to Know

A

• Know the T(1/2) of the marker when interpreting test results
• Know how the marker is removed or metabolized
• Use multiple markers when possible
– Increase sensitivity and specificity
• Nonspecific markers
– Cost saving, possible increase in sensitivity

36
Q

Types of Tumor Markers

A 
Serum Proteins or Molecules 
Enzymes
Ectopic Hormones 
Oncofetal Antigens 
Cellular Markers
Antigens Hormone Receptors
37
Q

Serum Proteins or Molecules

A

Many are indicative of host injury and response

– Hyperbilirubinemia
– C-reactive protein
– Haptoglobin
– Alpha 2-macroglobulin
– Beta 2 microglobulin

38
Q

Serum Proteins and Molecules

A

• Nonspecific for malignancy
• Typically indicate inflammatory response
– Chronic or acute

39
Q

Ectopic Hormones as Tumor Markers

A

Characteristics:

• Secreted by tumor cells into circulation
• Functionally identical to the native hormone
• Produce clinical syndromes (paraneoplastic)
• Assayed in serum

40
Q

Ectopic Hormones (Partial List)

A

• PTH (parathyroid hormone)
• GH (growth hormone)
• ACTH (adrenocorticotrophic hormone)
• TSH (thyroid stimulating hormone)
• HCG-β subunit (human chorionic gonadatrophin)

41
Q

Hormone Receptors

A
  • Receptors are found on the cell membrane or in the cytoplasm
    • Functional, can modify tumor behavior
  • Assayed in tissue, not in serum
42
Q

Hormone Receptors

A

• Estrogen
• Progesterone
– Primarily used in breast cancer

43
Q

Oncofetal Antigens

A

Carcinoembryonic Antigen Alpha-fetoprotein

44
Q

Oncofetal Antigens

A

• Produced by fetal cells during development but not normally produced by adult cells
• Produced by tumor cells by “de- differentiation”
• Used primarily to detect recurrence and metastasis, to follow the response to therapy, and to assess prognosis

45
Q

CEA

A

• Characteristics
– Glycoprotein produced by mucin-secreting glandular epithelium in the fetus

46
Q

CEA

Left gas pan chicken breast

A

• Useful as a tumor marker in:

– Colorectal carcinoma
– Pancreatic carcinoma
– Lung cancer
– Gastric cancer – Breast cancer

47
Q

CEA
• Elevated in 60 –90% of colorectal carcinomas

A

• Best used in monitoring postoperative/post- treatment recurrence
– Levels rise with recurrence and metastatic disease
– Levels fall with decreased tumor burden
• Most cost-effective approach for detecting metastatic disease

48
Q

Benign Conditions with Elevated CEA

His AC

A

• Cigarette smokers
• Inflammatory bowel disease
• Alcoholic cirrhosis
• Hepatitis
• Lack both specificity and sensitivity to detect early cancers

49
Q

Alpha-fetoprotein
• Characteristics:

A

– Glycoprotein
– Predominate component of serum proteins in early embryonic life
– Synthesized by fetal yolk sac, fetal liver, fetal gastrointestinal tract, and in minute amounts by the adult liver

50
Q

AFP

• Useful as a tumor marker in:

A

– Hepatocellular carcinoma
– Germ cell tumors of the testis
– Less regularly in carcinomas of the colon, lung, and pancreas

51
Q

AFP
• Hepatocellular Carcinoma

A

– Elevated in 60-75%

• False Positives
– Cirrhosis
– Massive liver necrosis
– Acute and Chronic hepatitis
– Normal pregnancy
– Fetal neural tube defects

52
Q

AFP
• Considered to be sensitive and specific enough to be used to screen for

A

HCC (hepatocellular carcinoma) in high risk populations
– Hepatitis B carriers

53
Q

Enzymes

A

• May be present in several tissues
• Most enzymes have structurally similar isotopes
• Assayed in the serum
• Released into circulation with increased cell turnover

54
Q

Clinically Useful Enzymes

A

• Alkaline phosphatase • Acid phosphatase

55
Q

Alkaline Phosphatase (ALP)
• Characteristics

A

– Several isoenzymes:
Bone, liver, placenta, intestine, and regan

• As a tumor marker
– Osteoblastic lesions
– Derived from the tumor itself

56
Q

ALP
• Benign Conditions Causing Elevated Levels

A

– Pregnancy (normal)
– Childhood
– Obstructive hepatic disease
– Hepatitis
– Paget’s disease
– Fractures

57
Q

Acid Phosphatase (ACP)
• Characteristics

A

– Numerous isoenzymes
– Bone, prostate, erythrocytes, platelets

• As a tumor marker
– Prostate carcinoma (from the prostate tissue/tumor)
– Bone
—osteolytic metastasis

58
Q

ACP
• Benign conditions with elevated levels

A

– Benign prostatic hyperplasia
– Mechanical trauma
• Accidental
• Instrumentation

59
Q

Antigens as Tumor Markers

A

Prostate Specific Antigen

CA 125
CA 15-3
CA 27-29
CA 19-9

60
Q

Prostate Specific Antigen (PSA)

A

• Serine protease-cleaves and liquefies seminal coagulum after ejaculation
• Produced by prostate epithelial cells
– Both benign and malignant
• Normally, minute amounts circulate in the blood

61
Q

PSA
• Increased levels occur with localized as well as advanced disease

A

• PSA levels are proportional to the volume of tumor
• Also raised in BPH, inflammation, and trauma
• Complexed PSA is elevated in prostate cancer, better than total PSA

62
Q

PSA
• The test has both a low sensitivity and specificity

A
  • There is no PSA level that ensures that the patient does not have prostate cancer
  • Best use:
    – Detecting residual disease or recurrence following treatment for prostate cancer
63
Q

PSA—What are the Problems?

A

• Total serum PSA levels of 4 ng/mL are used as the threshold for doing a biopsy
– Yet 20-50% of patients with clinically significant prostate cancers have values

64
Q

PSA—What are the Problems?
• Many prostate cancers do not cause clinical problems
– “Die with not of”

A

• Curative treatment (radical prostatectomy) of cancer confined to the gland is associated with morbidity and mortality
– 50% report permanent sexual dysfunction
– 25% will report some degree of incontinence

65
Q

PSA—What are the Problems?
• Of 1,000 men with symptomatic prostate hyperplasia:

A

– 400 will have elevated PSA levels or abnormal rectal exams
– 30 of these will have prostate cancer

66
Q

CA 125
• A high-molecular-weight antigenic determinant on a glycoprotein shed into the bloodstream by malignant cells derived from malignant cells derived from coelomic epithelium

A

• Increased in patients with ovarian, endometrial, pancreatic, and other cancers
• May be elevated in benign conditions:
– Early pregnancy, endometriosis, uterine leiomyoma, and benign ovarian cysts

67
Q

CA 125

A

• Although elevated levels are associated with an increased risk of ovarian cancer, 6% of normal women have similar levels
• Can be used to monitor recurrence

68
Q

CA 15-3

A

• Is an epitope of a large membrane glycoprotein encoded by the MUC1 gene that tumor cells shed into the bloodstream
• Most useful in following the course of treatment in women with advanced breast cancer
• Levels infrequently elevated early in the course of the disease

69
Q

CA 15-3

• Can be elevated in cancers of the:

A

– Lung
– Ovary
– Endometrium

– GI tract

70
Q

CA 15-3
• Can be increased in benign conditions such as:

A

– Chronic hepatitis
– TB
– Sarcoidosis
– Pelvic inflammatory disease
– Endometriosis
– Systemic lupus erythematosus
– Pregnancy and lactation

71
Q

CA 27-29

A

• Can be elevated in breast, colon, gastric, renal, lung, and ovarian, pancreatic, uterine and hepatic carcinoma
• Benign conditions with elevations include 1st trimester pregnancy, endometriosis, benign breast disease, renal disease, and hepatic disease

72
Q

CA 27-29

A

• Current best use: monitor patients during active therapy (together diagnostic imaging and history and physical exam)

73
Q

CA 19-9

A

• Produced by colon, pancreatic, and biliary cancers
• Not useful for screening, diagnosis, surveillance, or monitoring for colon or pancreatic cancer
• May have a role in monitoring therapy in patients with advanced cancer

Pathology (15 decks)

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