Tumour Markers Flashcards
Cancer
—______ growth of cells that can develop into a ______ or _____ and spread to other areas of the body.
Uncontrolled
solid mass or tumor
Tumorigenesis: ________ of ______
Metastasis-_____ of _______
Formation of tumors
Spreading of tumors
Oncofetal
Expressed during __________, then reexpressed in ________
the development of the fetus
tumors
Sensitivity
The likelihood that given the presence of disease, a test result ______________.
No ________
predicts the presence of the disease
false negatives.
Specificity
The likelihood that given the absence of disease, a test result ____________
No _________
excludes the presence of disease
false positives
A Tumour marker Is Produced by ______ or as an effect of __________
the tumor
the tumor on healthy tissue
A Tumour marker
Concentration ___eases with tumor progression
highest levels when ____________
Include diverse molecules such as serum ________,________ antigens, hormones, metabolites, receptors and enzymes
Incr
tumors metastasize
proteins; oncofetal
Tumor Marker Detection:
Ideally, a tumor marker would be:
A substance that is released (directly or indirectly?) into the _______ detectable at _____ concentrations
Tumor specific ( [high or low?} specificity)
(Present or absent?) in healthy individuals
readily detectable in body fluids.
Directly ; bloodstream
small a
High
Absent
Mention 2 ideal tumour markers that tick all the boxes
Unfortunately, no tumour marker fits this ideal model.
Application of tumor markers
_______ populations at risk
______ : Use results from markers, imaging, risk factors, and symptoms
Prognosis: ________ of the marker determines prognosis
Screening
Diagnosis
Concentration
all tumor markers are good screening tools
T/F
F
Not all
Application of tumor markers
Detection of ________: Once tumor is removed, elevations of marker can indicate ______
Monitoring ________: ____eased levels of tumor marker indicate therapy is working
____eased levels of tumor marker may indicate need for a change to therapy
recurrence; regrowth
response to treatment
Decr
Incr
Most commonly used method of tumors marker detection?
Immunoassay
Immunoassay
Challenges:
•Markers are often above_____
•Hook effect: excessive ____ marker concentrations result in ______
•Heterophile Antibodies
–Interfere with testing due to the presence of __________
•________,_______ and _______ cause interferences
linearity; high; false lows
circulating antibodies against animal immunoglobulin
Lipemia, hemolysis and antibody cross reactivity
Tumor markers: Enzymes
Increase due to ________ of cells
Indicate tumor ______
Examples
__________- Bone, liver, intestine
________- Prostate, lung, breast, colon, ovarian
__________-Liver, lymphomas, leukemias
___________-Prostate
metabolic demands; burden
Alkaline phosphatase
Creatine kinase
Lactate dehydrogenase
Prostatic acid phosphatase
Alkaline phosphatase(ALP):
Increased ALP activities are seen in primary or secondary ____ cancer. It’s level may be helpful in evaluating ___________ with _____ or ____ involvement.
liver
metastatic cancer with bone or liver
Placental ALP, a ____________ elevates in a variety of malignancies including _____,______,______cancers and _____ disease
regan isoenzyme
ovarian, lung, GI
Hodgkin’s
Prostatic acid phosphatase (PAP)
It is used for staging ____ cancer and for monitoring therapy. Increased PAP activity may be seen in _______,______, and ____ metastasis of other cancers and in some benign conditions such as ________ and _______.
prostate
osteogenic sarcoma, multiple myeloma and bone
osteoporosis and hyperparathyroidism
Prostate Specific Antigen (PSA)
– The clinical use of ____ has been replaced by PSA. PSA is much (more or less?) specific for screening or for detection early cancer. It is found in mainly ______ tissue.
PAP
More
Prostatic
PSA exists in two major forms in blood circulation.
The majority of PSA is _______________.
A minor component of PSA is ____.
complexed with some proteins
free
PSA testing itself is effective in detecting early prostate cancer.
F
PSA testing itself is not effective in detecting early prostate cancer.
Other prostatic diseases, urinary bladder ________ and ______ examination may lead an increased ______ in serum.
cateterization
digital rectal
PSA level
The ratio between ____ and ____ PSA is an reliable marker for differentiation of ________ from _______
free and total
prostatic cancer from benign prostatic hyperplasia.
The use of PSA should be together with __________ and followed by ________ for an accurate diagnosis of cancer.
digital rectal examination
transrectal ultrasonography
The greatest clinical use of PSA is in the __________ which includes ________,_______, and __________ therapy.
monitoring of treatment.
radical prostatectomy, radiation therapy and antiandrogen
After treatment, The PSA level should fall below the detection limit.
This may require ________. If PSA still at high level after that, it must be assumed that _________________
2-3 weeks
residual tumor is present.
______________ treatment may have direct effect on the PSA level that is independent of the antitumor effect. This subject must be considered always
Androgen deprivation therapy
Tumor markers: Endocrine/ hormones
Helpful in identification of:
_________
______ tumor
______ tumor
Examples
Beta-human chorionic gonadotropin
Calcitonin
Adrenocorticotropin hormone (ACTH)
Choriocarcinoma
Pituitary
Adrenal
Calcitonin
– Calcitonin is a hormone which ____eases blood calcium concentration.
– Its elevated level is usually associated with _________ cancer.
decr
medullary thyroid
Calcitonin levels correlates with tumor volume and metastasis.
T/F
T
Calcitonin is also useful for monitoring treatment and detecting the recurrence of cancer.
T/F
T
However calcitonin levels are also at a high levels in some patients with cancer of ____,______,_____, and _____ and in nonmalignant conditions such as ____ diseases, ____itis, _____ disease, hyperparathyroidism, myeloproliferative disordes and pregnancy.
lung, breast, kidney, liver
pulmonary; pancreat; Paget’s
Human Chorionic Gonadotropin (hCG)
–Hormone normally secreted by the ______ to _______
– Molecule consists of two subunits: ____ and ____
– Elevated in ______ tumors, _______ and _______ tumors of the ovary and testis
– Most immunoassays detect either the subunits or the total molecule
placenta; maintain pregnancy
alpha & beta
trophoblastic; choriocarcinoma; germ cell
Tumor markers: Oncofetal antigens
Become ______ in tumor formation
Examples
–______________
–____________
detectable
Carcino-embryonic antigen(CEA)
Alpha-fetoprotein
Oncofetal antigens are Considered normal in fetal development
T/F
T
Frequently Ordered Tumor Markers
Carcinoembryonic Antigen (CEA)
Expressed during ________ then re-expressed in _______
Clinical use
Used to detect colorectal, lung, breast ovarian, and GI cancers
Monitor therapy
fetal development ; tumor growth
Carcinoembryonic antigen (CEA)
– It is a ______ protein
– CEA is a marker for ___, gastrointestinal, lung and breast carcinoma.
– CEA levels are also elevated in ____ and some patients having benign conditions such as _____,_____,______ and _____ disease.
cell-surface
colorectal
smokers
cirrhosis, rectal polips, ulcerative colitis and benign breast
Carcinoembryonic antigen (CEA) is a well defined tumor marker.
T/F
T
CEA testing should be used for screening.
T/F
With reason
F
CEA testing should not be used for screening
Some tumors don’t produce CEA.
CEA testing should be used for ______ and _____
staging and monitoring therapy.
Frequently Ordered Tumor Markers
Alpha(α) Fetoprotein (AFP)
– Synthesized by the _____
– Re-expressed in certain types of tumors
– Normally functions as a ______ and helps to regulate ___________ in the ______
– Used to diagnose _______ carcinoma and ______ tumors (testes, ovaries)
fetal liver
transport protein
oncotic pressure in the fetus
hepatocellular; germ cell
AFP is useful for screening
T/F
T
AFP levels greater than _____ μg/L are indicative for cancer except pregnancy
1000
AFP can be useful in determining prognosis and monitoring therapy of liver cancers
T/F
T
AFP is also a prognostic indicator of survival.
T/F
T
Serum AFP levels is less than ___ μg/L in healthy adults.
10
Elevated AFP levels are associated with (shorter or longer?) survival time.
Shorter
___________ combined are useful in classifying and staging germ cell tumors.One or both markers are increased in those tumors.
AFP and hCG
Carbohydrate markers
These markers either are antigens on the ________ or are ________
tumor cell surface
secreted by tumor cells.
Carbohydrate markers
They are (low or high?)-molecular weight _____ or ________.
____________ have been developed against these antigens.
High ; mucins
blood group antigens
Monoclonal antibodies
Carbohydrate markers
Most reliable markers in this group are CA ____, CA ___ and CA _______
15- 3
125
19-9.
CA 15-3
– CA 15-3 is a marker for ____ carcinoma.
Elevated CA 15-3 levels are also found in patients with pancreatic, lung, ovarian, colorectal and liver cancer and in some benign breast and liver diseases.
breast
CA-15-3 is useful for diagnosis.
F
It is not useful for diagnosis.
CA-15-3 is most useful for monitoring therapy.
T/F
T
CA 125
– Although CA 125 is a marker for _____ and ______ carcinomas
-CA 125 can be elevated in pancreatic, lung, breast, colorectal and GI cancers, and in benign conditions such as cirrhosis, hepatitis, endometriosis, pericarditis and early pregnancy.
ovarian and endometrial
CA 125 is specific.
T/F
F
it is not specific.
CA 125 is useful in detecting ______________________
residual disease in cancer patients following initial therapy.
CA 125 is also useful in differentiating benign from malignant disease in patients with ___________
ovarian masses.
In the detection of recurrence, use of CA 125 level as an indicator is about ___ % accurate.
75
CA 19-9
– CA 19-9 is a marker for both ———- and ———- carcinoma.However elevated levels were seen in patients with hepatobiliary, gastric,hepatocellular and breast cancer and in benign conditions such as pancreatitis and benign gastrointestinal diseases.
colorectal and pancreatic
CA 19-9 levels correlate with pancreatic cancer staging
T/F.
T
CA 19-9 levels is useful in monitoring pancreatic and colorectal cancer.
T/F
T
Elevated levels of CA 19-9 can be indicative of _____ before detected by radiography or clinical findings in ______ and _________ cancer.
recurrence
pancreatic and colorectal
CA 15-3 =
CA 125=
CA 19.9=
Breast
Ovarian, endometrial
Colorectal, pancreatic
PROTEIN MARKERS
Most reliable markers in this group are _______ ,______,______,______
β2- microglobulin, ferritin, thyroglobulin and immunoglobulin.
β2-microglobulin
β2-microglobulin is a marker for ______,________ . It also increases in ___ inflammation and viral ______.
multiple myeloma, Hodgkin lymphoma
chronic; hepatitis
Ferritin
– Ferritin is a marker for ____, _____ , liver, lung and breast cancer.
Hodgkin lymphoma
leukemia
Thyroglobulin
– It is a useful marker for detection of _____ cancer.
Differentiated thyroid
Immunoglobulin:
– Monoclonal immunoglobulin has been used as marker for ________ for more than 100 years.
multiple myeloma
Monoclonal paraproteins appear as _______ in the globulin area of the serum protein electrophoresis.
sharp bands
Bence-Jones protein is a ________________________ in the _____ and it is a reliable marker for multiple myeloma.
free monoclonal immunoglobulin light chain
urine
RECEPTOR MARKERS
Estrogen and progesterone receptors are used in _____ cancer as indicators for __________
breast
hormonal therapy.
Patients with ______ estrogen and progesterone receptors tend to respond to hormonal treatment.
Those with _______ receptors can be treated by other treatment modalities.
positive
negative
Hormone receptors also serve as a prognostic factors in breast cancer.
T/F
T
Hormone receptors also serve as a prognostic factors in breast cancer.
Patients with ______ receptor levels tend to survive longer.
positive
Cytoplasmic estrogen receptors are now routinely measured in samples of breast tissue after surgial removal of a tumor.
T/F
T
Of patients with breast cancer, ___ % have tumors with estrogen receptor.
60
Approximately _____ of patients with estrogen receptor (+) tumors respond to the hormonal therapy.
___% of patients with estrogen receptor (-) tumors respond to the hormonal therapy.
two thirds
5
________ receptor testing is a useful adjunt to the estrogen receptor testing. Because ______ receptor synthesis appears to be (independent or dependent?) on estrogen action.
Progesterone
progesterone
Measurement of progesterone receptors provides a confirmation that _____________. Indeed breast cancer patients with both progesterone and estrogen receptor (+) tumors have a (higher or lower?) response rate to hormonal therapy
all the steps of estrogen action are intact
higher
Tumor markers can be used to confirm diagnosis
T/F
F
Tumor markers can never be used to confirm diagnosis
Tumor markers can be used to _______ diagnosis
Support
Reference value for prostatic specific antigen ?
0-4ng/mL
Levels of PSA greater than ___ng/ml strongly suggest cancer
10
(Majority or minority?) of PSA is bound to plasma proteins
(Majority or minority?) is free
Majority
Minority
CA _____ is a carcinoembryonic antigen
19-9
