Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Disease of Major Organs > Tumour markers > Flashcards

Tumour markers Flashcards

1
Q

What makes a good tumour marker?

A
  • Detectable only when tumour is present
  • Sensitive enough to detect small tumours at early stage of the disease
  • Be specific for certain types of malignancy
  • Correlate with amount of malignant tissue present
  • respond rapidly to tumour size

High sensitivity and specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a tumour marker?

A

Measurable analyte produced by a tumour which can help to diagnose the disease, provide prognostic information, identify correct treatment and monitor treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When are tumour markers primarily used?

A

Best used in post-treatment follow up but can be used throughout the diagnosis process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the problem with using tumour markers in screening?

A
  • Need to be detected early to limit spread and improve outcomes
  • Currently no marker acceptable for population screening in UK. Too many flase positives (low specificity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Example of tumour marker used in screening

A

Targeted screening in genetic linked disease such as BRCA1 and BRCA2 in breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why do tumour markers be poor prognostic tools?

A

Ideally need 100% specificity and sensitivity, but current markers arent near that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are tumour markers used in prognois?

A

If the tumour load is related to tumour marker then a survival estimate can be made

  • e.g HCG and AFP prognostic indicators of testicular teratoma
  • e.g. P53, E-cadherin, nm23H1 and MMP-2 used together to predict outcome of node negative breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are markers used in treatment?

A

Receptors used in treatment

- e.g. HER-2 positive breast cancers can be treated with herceptin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is required to monitor therapy using tumour markers?

A

A quantative relationship between tumour burden and tumour marker levels.

  • Assess efficacy of treatment
  • Detection of drug/chemo resistance and response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q 
Match half life to response
A. No change
B. Improvement 
C. Response 
D. Complete response
  1. Tumour marker < 10% T0 value
  2. Tumour marker within RR
  3. Tumour marker <50% T0 value
  4. Tumour marker >50% T0 value
A

A4
B3
C1
D2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the different types of tumour markers?

A

General - nonspecific markers of analytes

Functional markers

Classical tumour markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

State some general tumour markers? and the tumour associated?

A
  • calcium- Hypercalcaemia in malignancy
  • ESR - inflammation
  • Sodium - mineralocorticoid excess (Conns)
  • LDH - cellular/tissue damage
  • beta(2) microglobulin: can be used for severity+spread of multiple myeloma and some lymphomas, alsso present in crohns and hepatits
  • ALP- bone/liver metastases
  • Phosphate - PTHrP effect on phopshate excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some functional tumour markers?

A 
Pituitary
- prolactin, ACTH, GH, TSH
Parathyroid
- PTH
Adrenal cortex
- Aldosterone, cortisol
Adrenal medullary 
- Catecholamines, metabolites 
Ovary
- Oestrogen, testosterone 
GI tract
- insulin, glucagon, VIP, gastrin, 5HIAA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Functional tumour markers of adrenal cortex

A

Cortisol

Aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Functional tumour markers of parathyroid

A

PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Functional tumour markers of pituitary

A

Prolactin
ACTH
GH
TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Functional tumour markers of adrenal medulla

A

Catecholamines

Metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Functional tumour markers of ovary

A

Oestrogen

Testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Functional tumour markers of GI tract

A

Insulin, glucagon
VIP, Gastrin
5HIAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common pituitary tumour? symptoms?

A

Prolactinoma (benign tumour of pituitary gland)

  • Hyperprolactinaemia cause amenorrhea/infertility in females and in males ED, infertility and libido loss (prolactin inhibits GnRH)
  • Low estrogen due to high prolactin may lead to osteoporosis
  • pressure of prolactinoma on surrounding tissue manifests as headaches and vision blurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can you treat prolactinoma with?

A

Cabergoline, bromocriptine, norprolac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are differnt types of cushings syndrome?

A

ACTH independent (cushings syndrome)

  • Can be due to exogenous steroids
  • or from an adrenal tumour CRH

ACTH dependent (cushings disease)

  • Pituitary adenoma secreting ACTH so feedback from cortisol is useless
  • Or ectopic ACTH secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the GH excess of a tumour

A

GH excess occurs in benign pituitary tumours, cauign acromegaly in adults.
- Importantly GH is not a good diagnositic tool, but IGF-1 is more senstive so has inhert qualities of a good marker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How to test for GH excess?

A

Using a glucose tolerance test.

  • Patient will need to achieve hypoglycaemia and then load with glucose
  • In normal response GH secretion is inhibited in hyperglycaemia, but induced in hypoglycaemia
  • Acromegaly patients wont show this pattern

TEST MEASURES IGF-1, GLUCOSE AND GH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are medullary thyroid carcinomas?

A
  • First neoplastic manifestation of MEN-2
  • A tumour of the C-cells of the thyroid gland
  • high metastases rate

MEN2B patients will need thyroidectomy before 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the marker for MTC?

A

Calcitonin - secreted by C-cell hyperplasia/MTC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is conns syndrome?

A

Primary hyperaldosteronims caused by a benign adrenal adenoma (one) or hyperplasia (both adrenal glands)
- Results in low renin and high aldosterone

28
Q

What is are phaeochromocytomas?

A

Tumour of the chromaffin cells in the adrenal medulla. These tumours can produce catecholamines, adrenaline and noradrenaline.

  • Increased secretion of catecholamines –> hypertension
  • Present with headaches, sweating, tachycardia, palpitations
  • Present after MTC in MEN syndromes
  • In MEN2s but no MEN1
29
Q

What are soeme gut hormone tumours?

A

islet cell tumours of the pancreas

  • inuslinoma
  • glucagonoma
  • gastrinoma
  • VIPoma
30
Q

Where do carcinoid tumours arise?

A

Arise from argentaffin cells of the foregut, midgut and hindgut

  • predominent are midgut
  • incidental following appendectomy
31
Q

What is the carcionoid tumour associated with MEN?

A

MEN-1 foregut carcinoids

32
Q

Match the following:

  1. Foregut
  2. Midgut
  3. Hindgut

A. small intestine, appendix, proximal large bowel
B. Lungs, bronchi, stomach
C. Distal large bowel, rectum

A

1B
2A
3C

33
Q

What hormones can carcinoid tumours secrete?

A
  • Seretonin
  • ACTH
  • histamine.
  • dopamine
  • substance P
  • neurotensin
  • prostaglandins
  • kallikrein
34
Q

What is a carcinoid syndrome?

A

Caused by the release of sertonin and other vasoactive substances inot the systemic circulation
- manifesting as episodic flushin, wheezing, diarrhoea and eventual righ sided valve heart disease

35
Q

What tumours are associated with carcinoid syndrome?

A

Midgut carcinoid tumours, occur exclusively in the metastic setting

36
Q

Why is diagnosing carcinoid disease early hard?

A

Early diagnosis looks like irritable bowel disease

37
Q

What is a good marker for midgut carcinoids secreting serotonin? and how is it used?

A

5-HIAA the breakdown product of serotonin

  • sens 73% spec 100%
  • Although 5HIAA is only elevated once it has metastasized to the liver
  • Useful to estimate extent of disease and survival
  • Easily detectable in undiluted urine samples (24hr)
38
Q

What can cause falsely elevated 5HIAA tests?

A

Diet
- bananas, walnuts, plantain, hickory nuts, pineapple, pecans, kiwi fruit, avocados

Drugs that are contained in cought/cold medicines

  • Acetaminophne
  • Guaifenesin
  • I-dopa (parkinsons treatment)
39
Q

What is considered the best marker fo carcinoid tumours?

A

Chromagranin A is found elevated in 80-100% patients with carcinoid tumours
- Blood test

40
Q

What is a limitations to using chromagranin A to detect carcinoid tumours?

A

Positive results can be due to a neuroendocrine tumour

- Further testing is required for a definite diagnosis

41
Q

State some classical tumour markers

A
  • ADP, hCG, SP1
  • CA125, CA15.3
  • CEA, CA19.9
  • ChA
  • PSA
42
Q

What are the ACB recommendations for classical tumour markers

A
  • Use in diagnosis and monitoring
  • Lab need to regularly audit their services to review requesting patterns and use
  • interpret results in view of clinical and lab information
43
Q

What classical markers can be used in primary care?

A

PSA and CA125, but require follow up of patient being treated by secondary care

44
Q

What are two subtypes of testicular cancer?

A

Seminoma 40%

Non-seminoma 60%

45
Q

What are some classical markers of testiculare seminoma tumours?

A
  • These produe hCG (10%), placental like ALP (50%), LDH may be raised
  • LDH is non-specific so might have a role in monitoring
  • If AFP produced elements of germ cell tumour are present which changes treatment/management
46
Q

What are some classical markers of testiculare non-seminoma tumours?

A

90% produce AFP +/- hCG, where both values determine type, prognosis and therapy
- Where positive are essential for monitoring response, detecting residual tumour and recurrence

47
Q

What are some recommendations to AFP and hCG mesurements in testicular cancer?

A

Depends on stage and pathology but recommend AFP +/-

  • Measure 4-12 times anually
  • Twice annually (year 5)
48
Q

In what other conditions are AFP elevated?

A
  • Non-seminomatous germ cell tumour of ovary
  • hepatocellular carcinoma
  • Heptoblastoma (children)
  • Benign conditions: hepatitis, cirrhosis, biliary tract obstruction, alcoholic liver disease
  • Pregnancy as well
49
Q

What are the AFP clinical applications?

A
  • use in combination with hCG for non-seminomatous germ cell tumours
  • Independent prognostic marker of NSGCT
  • Diagnostic aid in hepatocellular carcinoma (HCC) and hepatoblastoma in patients with cirrhosis and focal lesions
  • AFP>200ug/L suggest HCC
  • AFP>400ug/L strong suggestive of HCC
50
Q

What marker should be used instead of AFP for liver mets?

A

CEA

51
Q

What is the marker of ovarian cancer? and when is it used?

A

CA125 - mainly used for monitoring treatment

- Also to distinguish between benign from malignant pelvic masses

52
Q

What should CA125 be used in conjugtion with?

A

Transvaginal ultrasound for early detection in women with hereditary symptoms

53
Q

What are the NICE guidelines for ovarian cancers in regards to CA125?

A
  • Check CA125 if symptomatic of ovarian cancer
  • If Ca125>35kU/L refer to ultrasound
  • Symptoms are: abdominal bloating, early satiety, loss of appetite, IBS like symptoms
54
Q

What are some key markers in breast cancers and what do they tell us?

A
  • Oestrogen progesteron receptors measured to ID those that can be treated with endocrine therapy
  • HER2 receptor positive allow for herceptin treatment
  • BRCA1 and 2 mutations increase the risk
55
Q

What is herceptins mechanism of treatment?

A
  • It is a monoclonal antibody interfering with HER2 receptors
  • HER2 regulate growth, adhesion, migration and differentiation
  • Herceptin inhibits cell overproduction
  • Does improve late stage metstatic breast cancers
56
Q

What is a classical tumour marker is used in breast cancer? how does the sensitivity change depedning on stage?

A
  • CA15.3 increased in breast cancer with distant mets
  • sensitivity of up to 36% in early stages
  • sens 100% in advanced disease
  • Major use is in post-treatment monitoring
57
Q

What other conditions are associated with raised CA15.3?

A

Raised in benign and malignant disease of lung, Gi and reproductive systems and also in liver disease

58
Q

What is the tumour marker can be used in colorectal malignancy?

A

CEA

  • 70% of malignancies but do not appear in early stage
  • Most useful in post treatment monitoring and as an indicator of recurrance
59
Q

What can cause false positives of colorectal malignancy?

A

Anything causing CEA release
Other malignancy
- Breast, lung, pancrease etc

  • Raised in benign conditions such as liver disease, obstructive jaundice, Crohns disease, pancreatitis, renal disease

Smokers as well

60
Q

What is the current colorectal cancer screenin in the UK?

A

National scheme using faecal occult blood

- All individuals >60 are screened

61
Q

What is CA19.9 and how can it be used as a tumour marker?

A

Produced by primary malignancy in pancreatic cancer

  • Low sensitivity and specificity in early diagnosis
  • Used to monitor treatment

This is a sialyated lewis antigen - patients lacking lewis antigen will not express CA19.9

62
Q

What causes falsely elevated CA19.9?

A
  • Colorectal, oesophageal and hepatocellular damage

- In bengign conditions: pancreatitis, cirrhosis and disease of bile ducts

63
Q

What is the prostate cancer marker? is this specific enough?

A

Prostate cancer considered the only malignancy causing elevated PSA, but PSA is not specific to prostate

  • Elevated levels in benign prostate hypertrophy, UTI, urinary retention, acute and chronic prostatitis
  • Transient elevation following TURP, prostate biopsy, prostate massage, ejaculation
64
Q

What are the main applicaitons to PSA?

A
  • With DRE can aid in diagnosis
  • prognosis
  • surveillance following diagnosis
  • monitoring therapy
65
Q

How can we distinguish between benign prostate hypertrophy and prostate cancer?

A

Total vs free PSA

  • Malignant prostate produce more bound PSA
  • low level of free in relation to total indicates cancer
  • high levels of free= normal prostate, BPH or prostatits
66
Q

What is a noninvasive multianalyte test for cancer?

A

CancerSEEK

  • 8 cancer protiens and gene mutations from circulating blood
  • sensitivity 70% (30-98%)

Disease of Major Organs (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions