Tumour Markers & Myelosuppression Flashcards
What are the 2 qualities a tumour marker should be?
Highly specific
Highly sensitive
Define sensitivity
The sensitivity of a marker describes its ability to detect those with a certain disease
Define specificity
The specificity of a marker describes its ability to accurately define those who are disease free.
Name the cell surface glycoproteins
CA125- ovarian carcinoma, pregnancy, endometriosis, periods, pancreatic, lung, colorectal
CA19.9- Pancreatic
CEA- COLORECTAL, pancreatic, gastric, breast, lung, smoking, IBD
Name the oncofetal proteins
HCG- hydatiform mole, choriocarcinoma, seminoma, pregnancy
αFP- hepatocellular carcinoma (in females), germ cell tumour (ovary/testis)
Germ Cell tumours (Teratoma): Raised αFP AND HCG
Name the tumour marker enzymes
Acid phosphatase
Alkaline phosphatase
Lactate dehydrogenase
Neuronespecific enolase
Name the tumour marker hormones
Thyroglobulin
ADH
Adrenocorticotrophic hormone
Name the tumour marker immunoglobulins
Light chains
Bence Jones protein- myeloma
What test should be done on a young male with widespread mets?
αFP, LDH, βHCG (pregnancy test)
Diagnoses chemo sensitive germ cell tumours
Where is αFP normally secreted?
Normal foetal yolk sac
Liver
Intestines
Undetectable after first year of life
What components of the blood drop with conventional chemo?
Pancytopenia: Leukocytes RBC Neutrophils Platelet count
What does bone marrow replacement cause?
Pancytopenia
More common in haematological malignancies
What haematological problems can para-neoplastic syndromes cause?
Pancytopenia
Single haematopoietic lineages to be affected
How is anaemia caused in cancer?
- Iron deficiency: Blood loss from tumour
- Macrocytic Not megaloblastic: Chemo
What investigations need to be done in myelosuppression?
Blood film
Measure heamatinics
Bone marrow aspirate
Trephine
How is anaemia treated?
- Hb<10= blood transfusion
- Preventing symptoms & reducing risk of transfusion reactions & viral transmission= recombinant erythropoetin
What are the clinical signs of thrombocytopenia?
Petechial haemorrhage
Spont. nosebleeds
Corneal haemorrhage
Haematuria
When is a platelet count significant?
< 10 x 10(9) associated with signify risk of spont bleeding (intracerebral haemorrhage)
When is a platelet transfusion required?
levels between 10-20 particularly in the presence of other complications (infection)
What is neutropenic sepsis?
Total white count
<1 x 10(9) with associated fever
How is neutropenic sepsis treated?
Immediate in-patient management with broad spec abx
What physical exams should not be done on a neutropenic sepsis patient?
Vaginal
Rectal
Risk of causing bacteraemia if mucosa is breached
What investigations need to be done on a neutropenic sepsis patient?
CXR Bloods Urine dip Sputum sample Throat swab
