Tumour markers Flashcards
What 2 structures passes the prostate
Urethra
Vas deference
What is the 3 zones of the prostate
- Transition zone surround urethra
- Central zone surround ejaculatory duct & TZ
- Peripheral zone
Where does benign growth start
Transitional zone
Where does malignant growth start
Peripheral zone
What is the clinical presentation of enlarged prostate
Bladder outlet obstruction w/ lower urinary tract symptoms
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
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
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
What is 5 causes of LUTS
BOO
Overactive bladder
Neurological diseases
Increased age/DM/CVD/obesity
Erectile dysfunction
What is the 2 main functions of the prostate
- Prostatic fluid production
- PSA production
What is prostatic fluid
Thin alkaline fluid which aid survival of sperm in acidic vaginal environment
What is PSA & where is it secreted
Glycoprotein serine protease enzyme (breakdown protein)
Secreted by columnar epithelial cells
What is the 2 functions of PSA
- Cleaves seminogelin & fibronectin proteins to liquefy sperm allowing to swim
- Aid fertilization
In what form is PSA secreted
Precursor
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
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
Is PSA cancer or organ specific
Organ
What 3 things cause a increase in PSA
Age
Benign neoplasm
Malignant neoplasm
What is the normal, grey zone & elevated levels of PSA
Normal is below 4
Grey zone is between 4-10
Elevated is above 10
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
What 6 factors cause a temporary increase in PSA
After ejaculation
Extensive exercise
Prostatic massage/DRE
Acute bacterial peritonitis
Acute urinary retention
Perineal biopsy
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
- Primary grade to largest area of tumor
- Secondary grade to next largest area
What is the 4 PSA screening guidelines in South Africa
- Black male over 40 years
- Family history of prostate or breast cancer
- Males over 45 years
- 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
- The tumour
- The body’s response to the tumour
What is 8 characteristics of an ideal tumour markers
- Highly specific to one tumour type
- Highly sensitive to cancer & undetectable due to physiological or benign disease
- Long lead time to ensure sufficient time for treatment
- Levels correlate with/ tumour mass & stage
- Prognostically useful to identify recurrence or relapse
- Short half life for regular monitoring
- Easily, non invasive & cheap measurement
- 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
- Screening of asymptomatic healthy person that has elevated risk for early diagnosis of disease
- Determining cancer risk due to history/genetic abnormalities ]
- Diagnosis for patient w/ signs & symptoms to differentiation between benign & malignant
- 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
- Tumour suppressor gene
- 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
- Diagnosis of multiple myeloma
- 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
- Diagnosis of neural tube defect in pregnancy
- Screening & diagnosis & HVV
- Screening in GCT
- 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
- Diagnose & monitor pregnancy
- Diagnosis of GCT
- 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
- CA125: ovarian cancer
- CA 15-3: breast
- 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
