Tumor markers Flashcards
Tumorigenesis occurs due to
Growth factors and oncogenes
Meaning of Sensitivity of Tumor Markers
No false negatives
Given presence of the disease, the test predicts presence
Meaning of Specificity of Tumor markers
No false positives
Given the absence of disease, the test excludes the presence
Challenges of immunoassay for detection of tumor markers
Markers above linearity
Hook effect(resulting in false lows)
Heterophile antibodies
Lipemia, hemolysis and antibody cross reactivity cause interference
Examples of Enzyme Tumor markers
- Alkaline Phosphatase
- Creatinine Kinase
- Lactate DH
- Prostatic acid phosphatase
Alkaline phosphatase is an enzymatic tumor marker present in
Bone
Liver
Intestine
Creatine kinase is an enzymatic tumor marker found in
Prostate
Lung
Breast
Colon
Ovarian
Lactate dehydrogenase is an enzymatic tumor marker found in
Liver
Lymphomas
Leukemias
Prostatic acid phosphatase is an enzymatic tumor marker found in
Prostate
Which enzyme is seen in Primary or Secondary liver cancer
ALP
Which enzyme level may be helpful in evaluating metastatic cancer with bone or liver involvement
ALP
Which regan isoenzyme elevates in ovarian, lung, GI cancers and Hodgkin’s disease
Placental ALP
Increased PAP activity may be seen in
Osteogenic sarcoma, Multiple myeloma and Bone metastasis of other cancers.
Osteoporosis
Hyperparathyroidism
The clinical use of PAP has been replaced by
PSA
PSA exists in 2 forms in blood circulation
Complexed PSA (majority)
Free PSA
PSA is more specific than PAP for detecting early cancer T/F
T
PSA testing itself is effective in detecting early prostate cancer T/F
F. It is not effective
Other prostatic diseases, urinary bladder catheterization and digital rectal exam may lead to a/an increased/decreased PSA level in serum
Increased
The ration between free and total PSA is a reliable marker for detection of prostatic cancer from BPH
F. It is unreliable
The use of PSA should be together with ………….. and followed by …………. for an accurate diagnosis of cancer
Digital Rectal Exam
Transrectal Ultrasonography
Serum level of PSA correlates with
Clinical stage
Grade
Metastasis
The greatest clinical use of PSA is
Monitoring of treatment
Treatment of Prostatic tumors and cancers include
Radical prostatectomy
Radiation therapy
Antiandrogen therapy
PSA levels should fall below the detection limit after treatment for how long
2-3 weeks
Androgen Deprivation Therapy may have DIRECT effect on the PSA level that is independent of the anti tumor effect T/F
T
Examples of Endocrine Tumor markers
- Beta-human Chorionic Gonadotropin
- Calcitonin
- Adrenocorticotropin Hormone
Elevated Calcitonin levels is usually associated with
Medullary Thyroid Cancer
Calcitonin reduces/increases CALCIUM concentration
reduces
Calcitonin levels are low in patients with cancer of lung, breast, kidney, liver T/F
F. They are high
Calcitonin levels are high/low in Hyperparathyroidism
High
Calcitonin levels are high in Paget’s disease and pancreatitis T/F
T
Calcitonin levels are low in pregnancy T/F
F. They are high
Also high in myeloproliferative disorders
hCH consists of how many subunits
- Alpha and Beta
hCG is elevated in what conditions
Trophoblastic tumors
Choriocarcinoma
Germ cell tumors of ovary and testis
Oncofetal antigens become detectable in tumor function T/F
T
Oncofetal antigens are elevated in fetal development T/F
T. They are normal in fetal development
Examples of oncofetal antigens
Carcino-embryonic antigen
Alpha-fetoprotein
CEA can be used to detect what cancers
Colorectal, Lung, Breast, ovarian and GI cancers
CEA levels are elevated in smokers T/F
T
CEA levels are elevated in which benign conditions
Cirrhosis
Rectal Polips
Ulcerative colitis
Benign breast disease
CEA testing should be used for screening, staging and monitoring therapy. T/F
F. Should not be used for screening. Some tumors don’t produce CEA
AFP is synthesized by
Fetal liver
AFP is Used to diagnose which types of tumors
Hepatocellular carcinoma
Germ cell tumors(testes, ovaries)
AFP is useful for screening, determining prognosis and monitoring therapy of liver cancers T/F
T
AFP levels greater than what level are indicative of cancer except pregnancy
1000 ug/L
AFP is a prognostic indicator of survival T/F
T
What’s the measure of serum AFP levels in healthy adults
10 ug/L
AFP and hCG combined are useful in
Classifying and staging cell tumors
Which markers are antigens on tumor cell surfaces or secreted by tumor cells
Carbonhydrate markers
What antibodies have been developed against carbonhydrate markers?
Monoclonal antibodies
Most reliable carbonhydrate markers
CA 15-3
CA 125
CA 19-9
Which carbonhydrate marker is a marker for Breast Carcinoma
CA 15-3
CA 15-3 is not useful for diagnosis. T/F
T
Which carbonhydrate marker is non-specific and a marker for ovarian and endometrial cancers
CA 125
CA 125 is a non specific marker for
Ovarian and endometrial cancers
Uses of CA 125 concerning cancers
- Detecting residual diseases or recurrence after initial therapy (75% accurate)
- Differentiating benign from malignant disease in patients with ovarian masses
CA 19-9 is a marker for
Colorectal and Pancreatic carcinoma
Elevated levels of CA 19-9 are also seen in Hepatobiliary, Gastric, Hepatocellular and Breast cancer. T/F
T
Also in pancreatitis and benign GI diseases
High CA 19-9 is indicative of recurrence after radiography T/F
F. It is indicative of recurrence before radiography
Examples of the Most reliable protein markers
B2-Microglobulin
Ferritin
Thyroglobulin
Immunoglobulin
B2-Microglobulin is a marker for
Multiple myeloma
Hodgkin lymphoma
What protein marker increases in chronic inflammation and viral hepatitis
B2-Microglobulin
Ferritin is a marker for
Hodgkin Lymphoma
Leukemia
Liver, Lung and breast cancer
Thyroglobulin is a useful marker for detection of
Differentiated Thyroid Cancer
Monoclonal immunoglobulin is used as a marker for
Multiple myeloma
Monoclonal paraproteins appear as …………….. in the ……………. area of the Serum Protein Electrophoresis
Sharp Bands
Globulin area
Bence-Jones protein is a free monoclonal immunoglobulin light chain in the urine and is a reliable marker for
Multiple Myeloma
Estrogen and Progesterone receptors are used in breast cancer as indicators for
Hormonal Therapy
Patients with negative estrogen and progesterone receptors tend to respond to hormonal treatment T/F
F. Patients with positive receptors respond to hormonal treatment
Hormone receptors serve as prognostic factors in breast cancer T/F
T
Patients with positive/negative receptor levels tend to survive longer
Positive
Of patients with breast cancer, what percentage have tumors with estrogen receptor
60%
What percentage of patients with estrogen receptor positive tumors respond to hormonal therapy
Two-thirds
What percentage of patients with estrogen receptor negative tumors respond to hormonal therapy
5%
Progesterone receptor synthesis is independent/dependent on estrogen action
Dependent
Measurement of progesterone receptors confirms that all the steps of estrogen action are intact T/F
T
