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Clinical Chem Snoopy style > Tumor Markers > Flashcards

Tumor Markers Flashcards

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1
Q

Describe Cancer
2nd leading cause of?

% of M/F that will develop invasive cancer?

lifetime risk of dying%?

A

2nd leading cause of mortality in developing countries

42% males 38% females will develope invasive cancer in their lifetime

Lifetime risk of dying M23% F19%

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2
Q

T/F marginalized groups are at higher risk,

what are some other factors/groups?

A

True

other factors are radicals/ethnic/sexual

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3
Q

Describe cancer and its definition

A

caused by uncontrolled growth of cells that form a new solid mass or tumor (neoplasm) - may be benign or malignant

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4
Q

What is metastasis

A

spreading to other areas of the body

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5
Q

What are the most common cancer types in M/F?

A

M: prostate/lung/other
F: breast/lung/other

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6
Q

T/F Thyroid cancer is common in men

A

false, it isn’t too often in men

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7
Q

T/F there were 1.6mil new cases of cancer in 2020

A

true

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8
Q

Describe the steps of cancer progression

A

proliferation - transformation - invasion - metastasis - vacularizaiton

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9
Q

Describe cancer staging 1-4

A

Stg 1 - localized primary tumor
stg 2 - invasion of tumor cells
stg 3 - into lymph nodes
stg 4 - metastisied invasion of distant tissues

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10
Q

Describe the overall theme of types of tumor markers

produced ?

A

biomarkers found in blood/tissues and when elevated, are linked to cancers

Produced directly by tumor or as an effort of tumor on healthy tissue

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11
Q

Describe the variety of diverse molecules in tumor markers briefly
n
m
r
e
O (describe what this is also)

A

normal
metabolic
receptor
enzymes
oncofetal Ag: produced during fetal development and elevated in cancer

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12
Q

T/F the enzymes that are elevated are specific and largely result from high metabolism

A

false, they are not specific but do result from high metabolism

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13
Q

T/F the demand of proliferative cells tend to correlate w/ tumor burden/clinically useful for therapy successes

A

true

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14
Q

Describe
Prostate specific Ag
Lactic dehydrogenase
Alkaline phosphatase

A

PSA: prostate cancer
LD: Hematologic
AP: bone/hepatic/leukemia

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15
Q

Describe Serum Protein markers
what do they do?
B-macroglob?

Immunoglobulins (MM) specif. meas

A

monitor cancer treatment

B-macroglob: located on surface of all nucleated cells
nonspecific marker of high cell turnover, common in tumors

Igs (MM) - specific measures of plasma cell production of monoclonal proteins

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16
Q

Describe Endocrine tumor markers
what kind of malignancies
diagnosis of?

A

endocrine malignancies
valuable in diagnosing Neuroblastomas, pituitary/adrenal adenomas

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17
Q

Describe oncofetal Ag
first?/expressed
when is it “turned on”
Acronyms?

A

first classes of tumor markers
expressed transiently during normal development

Turned on in formation of tumors
CEA (Alpha fetoprotein) AFP

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18
Q

Carbohydrate cancer Ag tumor markers

monoclonal defined…

Directed?

Best use? - tumors that sec..

A

monoclonal defined as Ag identified from human tumor extracts/cell lines

Ab directed towards specific carbohydrate/cancer Ag

Best use for monitoring treatment of tumors that secrete epitopes

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19
Q

Describe receptor tumor markers
Classify
serological
helps chose

A

classify tumors for therapy
serological methods
helps chose between endocrinde/cytotoxic therapies

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20
Q

Describe application of tumor marker detection
Ideal markers?

A

ideal markers: Tumor specific
absent in healthy individuals
readily detected in body fluids

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21
Q

T/F numerous markers are ID/d with high sensitivity and specificity to be used on targeted bases and aid in diagnosis

A

true

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22
Q

Briefly describe risk and screening assessments
weigh what?
no tumor mark?
most found in?

A

weigh benefit of disease with harms of over treatment (false pos)

No tumor marker can effectively screen asympt populations

Most found in normal/beningn cells as well as cancer

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23
Q

Describe targeted screenings

A

high incidence in a population

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24
Q

Describe family hxt of disease
ID what?

A

ID germline mutations
(breast/ovarian/colon)

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25
Q

What are the breast/ovarian tumor markers?

A

BRCA1/BRCA2

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26
Q

Describe family colon cancers
what gene? amount of people who will develop by _ yrs?

A

APC gene - 9% of people with gene will develop colon cancer by 40yrs

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27
Q

T/F T.M concentration decreases with tumor progression

When does it have high levels

A

false it increases, has high levels with metastisis

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28
Q

Describe levels of diagnosis
reflect
help p
may ind
high

A

reflect agressiveness of cancer
help predict outcome
may indicate malignancy/metastis
high levels - poor prognosis

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29
Q

T/F presence or absence of T.M are valuble

A

true, can be used to determine treatment

30
Q

T/F T.M levels can be used to monitor cancer and can be followed serially

A

true

31
Q

Lab considerations:
unique characteristics and concentrations of T.M have what two categories
1.) lack
2.) underrange

A

1.) lack of standardization makes comparison of serial results difficult (assay designs/calibrations..etc)
2.) Underrange of tumor marker concentration encountered clinically
(Na 12-160)
HGC 10-10,000,000

32
Q

Describe Immunoassays

Advantages

Unique factors

Linearity a/s
inc sample =

A

common method

Adv: automated testing, ease of use

Unique factor: assay linearity/Ag excess (hook effect) potential for hetrophile Ab

Linearity: span of analytical concentration which linear relationship exists between analyte/signal (samples over range = T.M)

33
Q

T/F dilutions are done with immunoassays with T.M and must be carefully considered of diluent/awareness of risk of errors w/ manual calculations

A

true

34
Q

Describe the Hook Effect
analyte concentration
captured?
lack?

actual concentration?

A

analyte concentration exceeds the range excessively - Ag excess with very high Ag []. Captured Ab becomes saturated
“lack of sandwich”

actual concentration underestimated
dilutions needed
typically only in sandwich assays

35
Q

Describe Heterophile Ab

A

individual with cirulating Ab against the reagents
significant interference with assasys

36
Q

Describe subsets of Heterophile Abs
Human?

HAMAS?

A

Human anti-animal Ab
HAMAs:
3 causes
pt given mouse monoclonal Ab
exposure to mice/idopathic

37
Q

What are some common analytical concerns with T.M assays?

A

Icteras
lipemia
hemolysis
Ab cross reactivity
Carry over

38
Q

Describe HPLC
used?
what kind of metabolites?
detects?

extraction?

A

high precision liquid chromatography
used to detect small molecules (Endocrine metabolites)
detects CATECHOLAMINE MET. in urine/plasma

extraction process applied to column separated by charge/size/polarity

39
Q

Describe Catecholamines met.
diagnostic
types?
t
p
n

A

diagnostic carcinoid tumor/pheochromocytoma/neuroblastoma

40
Q

Describe Neuroblastoma
malig in
increased
Acronym

A

malignancy in kids
increased epinephrine/norepin/dopamine
HVA

41
Q

Describe Pheochromocytoma
what kind of tumor
increased?
what happens to urine?

A

rare tumor w/ hypertesion
increased plasma met.
Urine vanilly

42
Q

Describe Carcinoid Tumors
secretes?
where?
what metabolite?
5…

A

seritonin sectreting tumors small intestines
serotonin metabolite
(5-HdA)

43
Q

Describe the HPLC detection
advantages
disadvantages

A

used to detect hormones/metabolites secreted by tumors diagnosis/monitoring

Adv: NO HOOK EFFECT
No lot to lot variation
No heterophile Ab

Dis: Labor intensive
More experience than automated

44
Q

Describe Immunohistochemistry/fluorescense
what aspirate
specific incubated w ?
presence?
uses?

A

solid tissue tumor markers (not in circulation)
Fine needle aspirate/biopsy
specific Ab incubated w/ tissue sections
- pres/abs of Ag
- uses calormetric/fluorecsense Ab

45
Q

example of immunohistochem/fluorescn. in the ID of estrogen in breast cancer
pos
neg

A

pos - normal
neg - chemotherapy

46
Q

Describe Enzyme Assays
most cant be used to?

ALP
LDH
PSA

A

most elemental enzymes cant be used to specifically ID a tumor
Except PSA
(used before immunoassy/oncofetal ag)

ALP: Bone/liver/leuk/sarcoma
LDH: liver/lymphoid/leuke
PSA: prostate

47
Q

Describe AFP testing
abund. spp- cp
normally?

other elevations?

A

alpha-fetoprotein
abund. serum proliferation - carcino. protein
normally synth. by fetal liver/re-expressed

Other elevations in pt w hepatocellular carcinoma HCC and serum cell tumors

48
Q

Describe regulation and physiology of alpha fetoprotein testing
ALB
What type of protein/what does it do?
regulates?
peaks?

healthy adults?
infants?

A

Glycoprotein - ALB
(Normal transport protein)
Involved in regulating fetal onconic pressure
Peaks at 1/10 alb levels at 30wks gestation

Healthy adults - upper norm 15mg/dl
infants high to low (age 7-10 months)

49
Q

Clinical usefullness of AFP
diagn of
elevated in

tumor is located where
can be caused by
spcificity?

range?

A

diag/stag/progression of HCC
Can be elevated in preg/malignancies

HCC tumor in the liver:
can be caused by chrome disease
high elevated AFP NOT specific

> 500mg HCC

50
Q

Describe Testicular cancer
subtypes

tumor staging?

A

several subtypes
seminomatous - malignant germ cells
Nonseminomatous - diff. into carcinoma

Tumor staging
10-20 Stg 1
30-80 Stg 2
90-100 Stg 3

51
Q

T/F AFP is used with HCG to calssify nonseminomatous tumors

A

true

52
Q

what is the ovarian cancer Ag
useful in?
w/o

May be elevated in?

A

CA-125
Usefully for detecting tumors at an early stage
monitor treatment w/o surgical

May be elevated in pts with endomitriosis/1st tri of preg/menstration

53
Q

T/F seromarkers for ovarian cancer are not for screening in asympt pts

A

true

54
Q

What are the immunoassay markers for ovarian cancer?

What are the levels for staging?

A

OC125/M11 Ab

50% stg1
90% stg 2
>90% stg 3/4

55
Q

t/f post-menopause with high levels >95 and palpable mass is positive 90% for OC125

A

TRUE

56
Q

Describe Cacinoembryonic Ag (CEA)
proto
expressed

widely used for ID of
large
elevated in
increased in

A

prototypical oncofetal Ag
expressed during development/re-exp in tumors

Widely used for COLORECTAL tumors/lung/breast/GI

Large Heterogenous glycoprotein/Ig superfamily

May be elevated in liver damage

Increased in smokers/radiation pts

57
Q

T/F Baseline for CEA before surgical rescetion/post surgery to continue removal drop to refrence ranges after 1-4 mos

A

true

58
Q

Describe HCG (human chorinic gonadotropi)
dim secreted by
elevated
tumors of

progn
diagn

maintains

A

dimeric glycoprotein hormone secreted by trophoblasts
elevated in troph. tumors
Tumors of ovaries/testes

Progn for ovarian cancer
Diagn for testicular cancer

Maintines corpus leteum in 1st trimester

59
Q

T/F HCG is not a good marker to detect gestational troph. disease (GTDs)

HCG levels in women with GTDs odten higher than pregn

It can be used with AFP for subtyping

A

false it is

True

true

60
Q

Is HCG/GTDs cleared by the FDA

A

no

61
Q

T/F etopic B-HCG occur elevated in ovarian linging and free B HCG is senstive and specific for aggressive neoplasma

A

true

62
Q

Describe PSA
glycopr produced
regulates
dissolves
most is
total?

A

prostate specific Ag
glycoprotein produced in epith. cells of acini and prostate
Regulate seminal fluid viscosity
DISSOLVE CERVICAL MUSCUS CAP
Most circulating is bound

TOTAL PSA to screen/monitor cancer

63
Q

T/F malignancies with prostate cancer dont have low levels of free PSA

A

false they do

64
Q

PSA:

What is PCA-3 used for
Whos at risk / age
PSA cut off?

What must you use?
Can recent ejaculations interfere?
Unique considerations?

A

PCA3 used to adress lack of specificity
Age 50yrs
Highest risk black americans
PSA <2….cut off 4.0

MUST USE FLUORECNESE
recent ejeculatios can interfere

HOOK EFFECT/HAMAS

65
Q

Describe Cancer Ag 15-3 (CA-15-3)
M
expressed
resposible for
what kind of pts?

A

Mucin 1 (MUC1) normally expressed in gland/epith cells of mammary glands/esoph..etc

responsible for encoding tumor Ags CA15-3 and CA-27-29

Breast cancer pts

66
Q

Describe Carb Ag 19-9
what ag?
what doesnt express? lacks?

what type of cancer?

A

mod. lewis (lewa) blood group Ag
Le-a-b dont express CA-19-9 (lacks fuicosyl)

Pancreatic cancer

67
Q

T/F not all lewis Ag - pts with pancreatic cancer are non secretors of CA19-9

A

true

68
Q

Describe Immunoglobulin free light chains (FLC)
mm
wm
mono…controlled by
what spike?
chains/testing?

clin applications?
1.) what assay
2.) baseline
3.) monitor pt w

A

MM increase free light chains
WM (IgM monoclonal)

monoclonal gammopathy controlled by IFE
M spike on SPE

2 chains, K or L - nephelometry

3 clinical applications:
1.) PLC assay
2.) baseline provides diag, in plasma cell dyscarias
3.) monitor pt with previous non sec. myeloma

69
Q

Describe HE4
R

A

function unknown
ovrexpression in ovarian cancer
Higher sensitivity for ovarian cancer than CA125
ROMA

70
Q

Describe NSE
enole
isoenzymes/dominant

present in
CSF disease
followup for what disorders

A

enolne enzyme 3 isoenzymes A/B/G
Predominant gamma isoenzyme
present in RBC

CSF- creutz-jakob disease

Followup- AUXILLARY TEST in neuroendocrine disorders

Clinical Chem Snoopy style (8 decks)

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