Tumor Markers Flashcards
what is a tumor?
abnormal growth of cells (benign or malignant)
what are environmental contributors of tumors?
tobacco (1a or 2a) benzene excess EtOH dietary (charred meat) poisonous mushrooms excessive sun exposure genetics obesity radiation HPV, HIV, Hepatitis B
what are the major factors that affect cancer?
location of origin
cell type
stage at diagnosis
resection
what is a tumor marker?
blood or urine test that is used to diagnose a malignancy, monitor recurrence, monitor treatment or screening
AFP
alpha-feta protein
-glycoprotein produced by fetal liver
when is the AFP elevated?
pregnancy
HCC (hepatocellular carcinoma)
gonadal cancers
gastric cancer and others
what is the diagnostic level of AFP if the pt is at a high risk for HCC?
serum levels of >500 mcg/L
what are the normal levels of AFP?
0-8 ng/mL
HCC is normally seen in what type of pt?
cirrhosis, chronic liver disease, hepatitis
what are the symptoms of HCC?
vague abdominal pain unexplained weight loss elevated LFT feel a mass early satiety (full to easy) obstructive jaundice hepatomegaly ascites (fluid leaking out of the liver) paraneoplastic syndrome
hypercalcemia of malignancy
common in cancer patients
testicular cancers
germ cell tumors
-one of the most curable solid neoplasms
seminoma
most common type of testicular cancer
nonseminoma
less common type of testicular cancer
what is the current 5 yr survival rate of testicular cancer
> 95%
- mostly they present as stage 1
- use of platinum based combination chemotherapy
- highly sensitive tumor markers to detect residual tumor
when is LDH used?
as a tumor marker for melanoma, lymphoma, leukemia, testicular cancer
which tumor markers should be elevated in nonseminoma germ cell tumors
AFP and or beta hCG
NSGCT
non-seminomal germ cell tumor
when would you use AFP?
monitoring response to treatment or as a screening tool for high risk patients
when would you use beta hCG
follow treatment because the tumor will produce it
what does LDH stand for?
lactate dehydrogenase
why would LDH increase
increased cell turnover in malignancies, which is why the LDH will rise
melanoma
bad dog, five year survival rate depends on stage of disease at the time of diagnosis
what are considered the “major” features
change in size
change in color
change in shape
what are considered the “minor” features
inflammation
bleeding or crusting
sensory change
lesion diameter
which tumor marker do you use with melanoma?
LDH
what tests will you do with melanoma?
CBC
serum LDH
chest xray for baseline (melanoma loves to met to the lungs)
CMP
what are the main four classes of lymphoma
ALL, CLL, AML, CML
lymphoblastic or myeloblastic
when are most blood cancers detected?
stage III or stage IV
what is the prognosis with acute leukemias?
AML, ALL
rapidly fatal if untreated
what is the prognosis for chronic leukemias
CML, CLL
may survive for years with modest treatment
NHL
non-Hodgkin lymphoma
classifications of lymphomas
Hodgkin or non
B-cells or T-cells
CEA
carcinoembrionic antigen (0-3 ng/mL)
what is CEA?
oncofetal protein that is elevated in the serum of pts with a variety of cancers including CRC (colorectal cancer)
why is CEA not a good screening marker?
it can be elevated in a lot of other things as well, smoker, UC, gastritis, peptic ulcer, diverticulitis
why would you use CEA?
established colon cancer
- CEA should return to baseline after complete resection (tumor would be present if it doesn’t)
- make sure they are not on chemo (can irritate GI and cause CEA to be falsely high)
CA 19-9
tumor marker related to the pancreatic hepatobiliary (very sensitive and specific) used to diagnose pancreatic cancer cholangiocarcinoma -bile duct -gall bladder cancer
what is the best mode of action for pancreatic cancer?
surgical resection is the only potential curative treatment
what are the tumor markers for breast cancer?
CA 15-3
CA 27-29
invasive breast cancer
not sure
in situ breast cancer
not sure
when would you use CA 15-3 and CA 27-29
follow pts with previous occurrence of br CA
- more useful in metastatic disease rather than screening
- if it goes up, I am wanting to follow it
CA 125
ovarian cancer tumor marker
- early stage 50% show elevation
- late stage 80% show elevation
when are most ovarian cancers discovered?
stage III
CA 125 can also be elevated in
other issues that have to do with the gut
PSA (prostate specific antigen)
may be used for screening*
glycoprotein expressed by both normal and neoplastic prostate tissue
-consistently expressed in nearly all prostate cancers
normal range of PSA
<4 ng/mL
PSA range can change according to
age (prostate size increases with age)
what can influence prognosis?
ethnicity (AAM may have more aggressive, diagnosed later, asian men have few and WM have lower “normal” range of PSA)
what are markers for carcinoid tumor?
5HIAA
Seratonin
Chromagranin A (byproducts that the tumor produces)
where are carcinoid tumors most common
GI, lung
what type of test is 5HIAA
urine
carcinoid tumor
tumor itself
carcinoid syndrome
constellation of symptoms that may continue even after resection
what is the normal value for SPEP?
not observed
SPEP
used to specifically look for an abnormal protein (monoclonal protein)
-used to diagnose multiple myeloma (cancer of the bone marrow)
multiple myeloma
body makes abnormal plasma cells that go out into the blood
