Tumour markers Flashcards by Daniëll de Bruyn

What 2 structures passes the prostate

Urethra
Vas deference

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What is the 3 zones of the prostate

Transition zone surround urethra
Central zone surround ejaculatory duct & TZ
Peripheral zone

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Where does benign growth start

Transitional zone

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Where does malignant growth start

Peripheral zone

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What is the clinical presentation of enlarged prostate

Bladder outlet obstruction w/ lower urinary tract symptoms

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What is the 6 effects of chronic bladder outlet obstruction

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

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What is the 6 causes of bladder outlet obstruction

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

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What is the 3 categories of LUTS symptoms & examples

Storage: frequency & urgency, nocturia, increased bladder sensation
Voiding: slow/split stream, hesitant, dribble
Post-void: feel incomplete urination & post dribble

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What is 5 causes of LUTS

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

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What is the 2 main functions of the prostate

Prostatic fluid production
PSA production

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What is prostatic fluid

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

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What is PSA & where is it secreted

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

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What is the 2 functions of PSA

Cleaves seminogelin & fibronectin proteins to liquefy sperm allowing to swim
Aid fertilization

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In what form is PSA secreted

Precursor

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What is the normal presentation of PSA in the blood

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

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

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Is PSA cancer or organ specific

Organ

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What 3 things cause a increase in PSA

Age
Benign neoplasm
Malignant neoplasm

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

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

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What is important to remember w/ PSA & cancer diagnosis

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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What 6 factors cause a temporary increase in PSA

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

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How is diagnostic accuracy improved w/ PSA in grey zone

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

What is 3 indications of prostate biopsy

Hard knobby prostate
PSA elevated
Free/total PSA ratio <0.25

What is a prostate biopsy

Transracial biopsy getting multiple cores from multiple areas

What is the grades given by Gleason score

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

What is the 4 PSA screening guidelines in South Africa

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

What is a tumour marker

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

What 2 things can produce tumour markers

1. The tumour 2. The body’s response to the tumour

What is 8 characteristics of an ideal tumour markers

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

What is the 2 limitations w/ tumour markers

Lack adequate sensitivity & specificity

What are 4 things tumour markers are used for

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

What is lactase dehydrogenase

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

What is alkaline phosphatase

Non specific response to bone metastases

What is oestrogen & progesterone receptors testing used for

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

What is 2 examples of genetic markers

1. Tumour suppressor gene 2. Oncogenes

What is tumour suppressor genes function

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

What is the function of oncogene

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

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

Phaeochromocytomas diagnosis

What is 2 examples of catecholamine metabolites

Metanephrine & normetanephrine

How is catecholamine metabolites measured

Urine & blood

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

Carcinoid tumour of gut/lung for diagnosis

What is an example of serotonin metabolite

5-HIAA

How is serotonin metabolites measured

In urine

What is the 2 functions of the paraproteins markers

1. Diagnosis of multiple myeloma 2. Monitoring treatment

What 3 things does increased levels of alpha-fetoprotein indicate

Pregnancy HCC Non-seminomatous germ cell tumour

What is the 4 functions of the AFP markers

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

What 3 things does increased levels of human chorionic gonadotropin indicate

Pregnancy Tropoblastic tumours GCT

What is the 3 functions of the HCG markers

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

What is the function of the CEA markers

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

What 3 things does increased levels of carcinoembryonic antigen indicate

Colorectal cancer Esophageal adenocarcinoma Breast cancer

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

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

What 2 things are CA125 used for

Screening in strong family history Monitoring response to therapy

What is CA15-3 used for

Monitoring therapy & disease progression

What is CA19-9 used for

Monitoring therapy & disease progression