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CLINICAL CHEMISTRY CHAPTER 30

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Title: CLINICAL CHEMISTRY CHAPTER 30


1
CLINICAL CHEMISTRYCHAPTER 30
  • TUMOR MARKERS

2
  • Introduction
  • Cancer is the second leading cause of death in
    the Unites States Whats number one?
  • Generally speaking, the sooner its detected the
    sooner treatment can begin and the better the
    prognosis will be
  • Wouldnt it be nice if there were relatively
    simple blood tests that could be used to detect
    cancers? Actually, there are Sort of

3
Key Terms
  • Cancer
  • Neoplasm
  • Oncofetal proteins
  • Oncogenes
  • Staging
  • Tiumor Markers
  • Tumor associated antigens
  • Tumor specific antigens
  • PSA
  • CEA
  • AFP
  • CA125
  • hCG

4
  • Objectives
  • Define what a tumor marker is
  • List the various substances that can be
    classified as tumor markers
  • Discuss the roles of tumor markers in cancer
    management
  • List the ideal characteristics of a tumor marker
  • List the common tumor markers that are commonly
    tested in the clinical laboratory and the
    malignancies they are associated with

5
  • Why are tumors markers important?
  • Cancer is the 2nd leading cause of death in the
    United States
  • More than 50 documented types of malignancies
  • Common cancers
  • Men Lung , Prostate , Colon
  • Women Breast, Lung, Colon, Uterine
  • Overall
  • 1 Lung
  • 2 Prostate
  • 3 Breast

6
  • Tumor Markers
  • Tumor markers are biological substances produced
    by malignant cells or other non malignant cells
    in response to a malignancy
  • Tumor markers can differentiate malignant cells
    from normal cells
  • Tumor markers can be found in
  • Plasma
  • Inside cells
  • On cell membranes
  • Plasma tumor markers can be measured as
    laboratory tests
  • Cellular tumor markers can be detected with
    special stains or other special techniques

7
  • Ideal tumor marker characteristics
  • Sensitive
  • Detectable at low concentrations
  • Sensitive to small or new malignancies
  • Specific
  • Presence of a given marker identifies an exact
    malignancy
  • Concentration proportional to tumor size ( burden
    )
  • Concentration changes with growth or reduction of
    maligncy
  • Concentration is low after remission ( cure )
  • Concentration is a good indicator of prognosis
  • Short half life ( concentration reflects
    current conditions )

8
  • Reality of tumor markers
  • Unfortunately, most tumor markers only possess
    some of the ideal characteristics ( never all of
    them ) !
  • Most tumor markers are not very sensitive and
    are poor screening tests for the detection of
    malignancies
  • Most tumor markers are best utilized to confirm
    or monitor already diagnosed cancers

9
  • Tumor specific antigens
  • Specific products of malignant cells
  • Tumor associated antigens
  • Oncofetal antigens - Antigens present in normal
    fetal growth and stimulated by malignancies later
    in life

10
  • Different types of tumor markers
  • Enzymes
  • Hormones
  • Fetal antigens
  • Proteins
  • Cancer associated antigens
  • Genetic defects

11
  • Laboratory techniques for analysis of tumor
    markers
  • Large variability's
  • Results and normal ranges show poor
    reproducibility
  • Each lab must establish its own normal ranges to
    reflect different methodologies
  • EIA techniques are the most common

12
  • CEA ( Carcinoembryonic Antigen )
  • Oncofetal antigen
  • Best tumor marker for monitoring of colon cancer
  • Also elevated in
  • Smokers
  • Alcoholic cirrhosis
  • Ulcerative colitis
  • Not specfcic for colon cancer
  • Good correlation with treatment and prognosis of
    colon cancer
  • ? CEA after surgical removal of tumor
  • ? CEA if malignancy re-occurs or metastasizes (
    spreads )
  • Levels correlate well with chemotherapy and
    irradiation treatment

13
  • Alpha Feto - Protein ( AFP )
  • Oncofetal antigen ( synthesized during normal
    fetal development )
  • ? in pregnancy and certain malagnancies
  • Useful tumor marker for monitoring
  • Liver cancer
  • Gonadal malignancies
  • Colon cancer

14
  • Prostate Specific Antigen ( PSA )
  • PSA is a tissue specific enzyme secreted by
    malignant prostate cells
  • PSA is present in low concentrations of normal
    males, but elevated in malignancies and other
    conditions
  • Good screening test for the detection of
    prostate cancer in older males and the monitoring
    of previously diagnosed tumors

15
  • A FEW OTHER TUMOR MARKERS
  • CA 125 ( Carcinoma Associated 125 )
  • PROTEIN UTILIZED TO EVALUTE GONADAL ( OVARIAN )
    CANCERS
  • CA125 is not efficient in detecting early (
    more treatable ) ovarian cancers
  • CA125 is useful in detecting late ovarian
    cancers and recurrence of cancers
  • False positives may occur, resulting in
    unnecessary treatment
  • 75 of ovarian cancers are not diagnosed until
    late in the disease 14,000 deaths in 2002

16
  • HCG ( Human Corionic Gonadaltropin )
  • Hormone Increases in gonadal tumors
  • Ovarian and testicular cancers
  • Same hormone utilized for pregnancy testing
  • CA 15-3
  • Associated with breast cancer
  • Abnormal plasma proteins
  • Bence Jones Protein ( Multiple Myeloma )
  • IgM antibody ( Waldenstroms Disease )

17
TOP 10
  • Tumor Markers - Substances produced by
    malignant cells or by other non-malignant
    cells in response to the malignancy
  • Tumor markers can be a variety of substances (
    proteins , enzymes , ect )
  • AFP Liver cancer
  • CEA Colon cancer
  • PSA Prostate cancer
  • HCG Ovarian / Testicular Cancer

18
Tumor Marker Links
http//cis.nci.nih.gov/fact/5_18.htm http//www.m
edstudents.com.br/onco/onco1.htm http//training.
seer.cancer.gov/module_diagnostic/unit03_tumor_mar
kers.html
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