tumor markers/metastasis

Question 1

Alkaline phosphatase

AP/alk phos

Answer 1

Metastases to bone or liver, Paget disease of bone, seminoma (placental ALP)

Question 2

α-fetoprotein

α-FP

Answer 2

Hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, mixed germ cell tumor.
Normally made by fetus. Transiently elevated in pregnancy. High levels associated with neural tube and abdominal wall defects, low levels associated with Down syndrome.

Question 3

β-hCG

Answer 3

Hydatidiform moles and Choriocarcinomas (Gestational trophoblastic disease), testicular cancer, mixed germ cell tumor.
-Produced by syncytiotrophoblasts of the placenta.

Question 4

CA 15-3/CA 27-29

Answer 4

Breast cancer

Question 5

CA 19-9

Answer 5

Pancreatic adenocarcinoma

Question 6

CA 125

Answer 6

Ovarian cancer

Question 7

Calcitonin

Answer 7

Medullary thyroid carcinoma

Question 8

CEA

Answer 8

CarcinoEmbryonic Antigen. Very nonspecific but produced by ∼ 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas.

Question 9

PSA

Answer 9

Prostate-specific antigen. Prostate cancer.

Can also be elevated in BPH and prostatitis. Questionable risk/benefit for screening.

Question 10

P-glycoprotein

Answer 10

multidrug resistance protein 1 (MDR1). Classically seen in adrenal cell carcinoma but also expressed by other cancer cells (eg, colon, liver). Used to pump out toxins, including chemotherapeutic agents (one mechanism of decreased responsiveness or resistance to chemotherapy over time)

Question 11

Cachexia mediators

Answer 11

TNF, IFN-γ, IL-1, and IL-6

Question 12

common metastases

Answer 12

Most sarcomas spread hematogenously; most carcinomas spread via lymphatics (except hepatocellular carcinoma, renal cell carcinoma, follicular thyroid carcinoma, and choriocarcinoma).

Question 13

metastasis to brain

Answer 13

1o Tumor:
Lung > breast > prostate > melanoma > GI.
-50% of brain tumors are from metastases Commonly seen as multiple well-circumscribed
tumors at gray/white matter junction.

Question 14

metastasis to liver

Answer 14

1o Tumor: Colon&raquo_space; stomach > pancreas

Liver and lung are the most common sites of metastasis after the regional lymph nodes

Question 15

metastasis to bone

Answer 15

1o Tumor: Prostate, breast > lung, thyroid, kidney
Bone metastasis&raquo_space; 1° bone tumors (eg, multiple myeloma, lytic). Common mets to bone: breast (mixed), lung (mixed), thyroid (lytic), kidney (lytic), prostate (blastic). Predilection for axial skeleton