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Case 11: Male Reproductive System > Tumour markers > Flashcards

Tumour markers Flashcards

1
Q

What 2 structures passes the prostate

A

Urethra
Vas deference

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2
Q

What is the 3 zones of the prostate

A
  1. Transition zone surround urethra
  2. Central zone surround ejaculatory duct & TZ
  3. Peripheral zone
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3
Q

Where does benign growth start

A

Transitional zone

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4
Q

Where does malignant growth start

A

Peripheral zone

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5
Q

What is the clinical presentation of enlarged prostate

A

Bladder outlet obstruction w/ lower urinary tract symptoms

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6
Q

What is the 6 effects of chronic bladder outlet obstruction

A

Urinary retention
UIT
Hematuria
Renal calculi
Renal insufficiency (due to increased P)
Lower UT symptoms

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7
Q

What is the 6 causes of bladder outlet obstruction

A

Urethral stricture
Primary bladder neck obstruction
Bladder neck contracture
Meatal stenosis
Prostate cancer
Detrusor sphincter dyssunergia

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8
Q

What is the 3 categories of LUTS symptoms & examples

A
  1. Storage: frequency & urgency, nocturia, increased bladder sensation
  2. Voiding: slow/split stream, hesitant, dribble
  3. Post-void: feel incomplete urination & post dribble
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9
Q

What is 5 causes of LUTS

A

BOO
Overactive bladder
Neurological diseases
Increased age/DM/CVD/obesity
Erectile dysfunction

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10
Q

What is the 2 main functions of the prostate

A
  1. Prostatic fluid production
  2. PSA production
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11
Q

What is prostatic fluid

A

Thin alkaline fluid which aid survival of sperm in acidic vaginal environment

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12
Q

What is PSA & where is it secreted

A

Glycoprotein serine protease enzyme (breakdown protein)
Secreted by columnar epithelial cells

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13
Q

What is the 2 functions of PSA

A
  1. Cleaves seminogelin & fibronectin proteins to liquefy sperm allowing to swim
  2. Aid fertilization
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14
Q

In what form is PSA secreted

A

Precursor

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15
Q

What is the normal presentation of PSA in the blood

A

Small amount diffuse into plasma & bind to proteins forming complexed PSA
Small amount are inactive & released into plasma forming free PSA

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16
Q

What is the presentation of PSA in the blood w/ cancer

A

Disrupted basement membrane allow more PSA into the plasma & more complexed PSA is present

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17
Q

Is PSA cancer or organ specific

A

Organ

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18
Q

What 3 things cause a increase in PSA

A

Age
Benign neoplasm
Malignant neoplasm

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19
Q

What is the normal, grey zone & elevated levels of PSA

A

Normal is below 4
Grey zone is between 4-10
Elevated is above 10

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20
Q

What is important to remember w/ PSA & cancer diagnosis

A

PSA is a continuous parameter
High levels does not necessarily mean cancer it increases likelihood
Low levels of PSA does not eliminate cancer

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21
Q

What 6 factors cause a temporary increase in PSA

A

After ejaculation
Extensive exercise
Prostatic massage/DRE
Acute bacterial peritonitis
Acute urinary retention
Perineal biopsy

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22
Q

How is diagnostic accuracy improved w/ PSA in grey zone

A

Measurement of free PSA to calculate ratio
If ratio of free/total PSA is below 0.25 there is an increased risk of cancer

23
Q

What is 3 indications of prostate biopsy

A
  1. Hard knobby prostate
  2. PSA elevated
  3. Free/total PSA ratio <0.25
24
Q

What is a prostate biopsy

A

Transracial biopsy getting multiple cores from multiple areas

25
Q

What is the grades given by Gleason score

A
  1. Primary grade to largest area of tumor
  2. Secondary grade to next largest area
26
Q

What is the 4 PSA screening guidelines in South Africa

A
  1. Black male over 40 years
  2. Family history of prostate or breast cancer
  3. Males over 45 years
  4. LUTS history or suspicion of cancer
27
Q

What is a tumour marker

A

Something that is measurable that is altered in precancerous or cancerous conditions that provide information on the cancer

28
Q

What 2 things can produce tumour markers

A
  1. The tumour
  2. The body’s response to the tumour
29
Q

What is 8 characteristics of an ideal tumour markers

A
  1. Highly specific to one tumour type
  2. Highly sensitive to cancer & undetectable due to physiological or benign disease
  3. Long lead time to ensure sufficient time for treatment
  4. Levels correlate with/ tumour mass & stage
  5. Prognostically useful to identify recurrence or relapse
  6. Short half life for regular monitoring
  7. Easily, non invasive & cheap measurement
  8. Clinical validated in large prospective trial
30
Q

What is the 2 limitations w/ tumour markers

A

Lack adequate sensitivity & specificity

31
Q

What are 4 things tumour markers are used for

A
  1. Screening of asymptomatic healthy person that has elevated risk for early diagnosis of disease
  2. Determining cancer risk due to history/genetic abnormalities ]
  3. Diagnosis for patient w/ signs & symptoms to differentiation between benign & malignant
  4. Monitoring disease progression/treatment response & getting a prognosis
32
Q

What is lactase dehydrogenase

A

Non specific tumour marker & used for staging of lymphoma
Rich in glycolytic enzymes enzymes due anaerobic metabolism

33
Q

What is alkaline phosphatase

A

Non specific response to bone metastases

34
Q

What is oestrogen & progesterone receptors testing used for

A

Used in breast cancer as indicator of susceptibility to hormonal therapy
+ test = survival increased

35
Q

What is 2 examples of genetic markers

A
  1. Tumour suppressor gene
  2. Oncogenes
36
Q

What is tumour suppressor genes function

A

To suppresses expression of malignancy
Loss of function is due to mutation associated with/ tumours

37
Q

What is the function of oncogene

A

Due to mutation in proto-oncogenes there is activation of cell proliferation causing a malignancy common in hematological malignancies

38
Q

What does increased levels of catecholamine metabolites indicate & purpose of testing

A

Phaeochromocytomas diagnosis

39
Q

What is 2 examples of catecholamine metabolites

A

Metanephrine & normetanephrine

40
Q

How is catecholamine metabolites measured

A

Urine & blood

41
Q

What does increased levels of serotonin metabolites indicate & purpose of testing

A

Carcinoid tumour of gut/lung for diagnosis

42
Q

What is an example of serotonin metabolite

A

5-HIAA

43
Q

How is serotonin metabolites measured

A

In urine

44
Q

What is the 2 functions of the paraproteins markers

A
  1. Diagnosis of multiple myeloma
  2. Monitoring treatment
45
Q

What 3 things does increased levels of alpha-fetoprotein indicate

A

Pregnancy
HCC
Non-seminomatous germ cell tumour

46
Q

What is the 4 functions of the AFP markers

A
  1. Diagnosis of neural tube defect in pregnancy
  2. Screening & diagnosis & HVV
  3. Screening in GCT
  4. Monitoring in patient w/ elevated AFP for response to treatment
47
Q

What 3 things does increased levels of human chorionic gonadotropin indicate

A

Pregnancy
Tropoblastic tumours
GCT

48
Q

What is the 3 functions of the HCG markers

A
  1. Diagnose & monitor pregnancy
  2. Diagnosis of GCT
  3. Monitoring response to treatment
49
Q

What is the function of the CEA markers

A

NOT FOR SCREENING/DIAGNOSIS
Used for monitoring w/ known elevated CEA

50
Q

What 3 things does increased levels of carcinoembryonic antigen indicate

A

Colorectal cancer
Esophageal adenocarcinoma
Breast cancer

51
Q

What is the 3 carbonic antigens used for tumour markers & what do each indicate

A
  1. CA125: ovarian cancer
  2. CA 15-3: breast
  3. CA 19-9: pancrease adenocarcinoma
52
Q

What 2 things are CA125 used for

A

Screening in strong family history
Monitoring response to therapy

53
Q

What is CA15-3 used for

A

Monitoring therapy & disease progression

54
Q

What is CA19-9 used for

A

Monitoring therapy & disease progression

Case 11: Male Reproductive System (9 decks)

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