Tumor markers - cancer marker

2. What are Tumor markers ?
•Biochemical indicators of the presence of a
tumor
•Substances that can often be detected in
higher than normal amount in the blood,
urine or body tissues of some patients with
certain types of cancer
•Include cell surface antigens, cytoplasmic
proteins, enzymes and hormones

3. Tumor markers
•Produced either by the tumor itself or by
the body in response to the presence of
cancer.
•The utility in clinical medicine is to
support the diagnosis, determining in the
response to therapy, follow up , and
prognosis

4. Changes in tumor marker concentration
during the course of disease:
No response
to treatment
Good
response
Remission
Relapse
No treatemnt
Second
remission

5. When are they useful ?

6. 1. Screening To identify early cancer risk
2. Diagnosis To diagnose the cancer
3. Staging To assess & stratify the risk
4. Prognosis To predict the outcome
5. Localization To locate the primary
6. Therapy To target the therapy
7. Surveillance To detect recurrence in F-Up
8. Monitoring To evaluate response to Rx.

7. 1. Lack of Specificity – false positives
2. Lack of Sensitivity - false negatives
3. Benign diseases - positive CA 125 or CEA
4. Smokers have raised CEA
5. Normal persons also have small amounts
6. Higher levels only with large tumor volume
7. Some cancers never have higher levels

8. Tumor Markers

10. • Prostate Specific Antigen (PSA) is a glycoprotein.
• Ideal as a tumor marker, high tissue specificity
• High sensitivity for prostate cancer
• Also elevated in BPH & prostatitis
• Useful in
– Dx. & follow up of prostate Ca, Prognostic factor
– To monitor recurrence & response to treatment
– ? For screening of prostate cancer along with
DRE

11. • 80% of ovarian cancer detected by the
monoclonal antibody to CA-125
• Elevated in Ovarian, Endometrial, Pancreatic,
Lung, Breast, Colon cancers and also in
• Menstruation, Pregnancy, Endometriosis and
other gynecological and non gynec conditions.
• Useful in monitoring ovarian Ca recurrence & Rx.
• Screening of high risk population (BRCA1-2
Carriers); Not useful for routine screening.

12. • Alfa Feto Protein is a glycoprotein synthesized
by the liver, yolk sac, GI tract.
• In Hepatocellular Cancer: It is diagnostic
(>500) & also useful for screening of high risk
population (HBV, HCV)
• Benign conditions: hepatic parenchymal
inflammation, hepatic necrosis, pregnancy,
primary biliary cirrhosis, extra hepatic biliary
obstruction give positive test.
• Testicular germ cell tumor (embrional or
endodermal)
• Diagnosis, Prognosis, monitor recurrence &
response.

13. • Complex glycoprotein that is associated with the plasma
membrane of tumor cells.
• Elevated specially in Colon cancer, Adeno. Cancer of
uterus
• Normal pre Rx CEA indicates no metastasis
• Also in Pancreatic, Gastric, Lung, breast & Ovarian
Cancer
• Also in cirrhosis, inflammatory bowel disease, chronic lung
disease, pancreatitis, fibrocystic breast disease
• 19% of smokers, 3% of healthy population
• Not satisfactory for screening for a healthy population
• Good for monitoring recurrence & to monitor Rx.

14. CA 19-9 is elevated in
• In 21-42% patients of gastric Cancer
• In 20-40% patients of colonic Cancer
• In 71-93% patients of pancreatic Cancer
• For DD of benign from malignant disease
• Dx, FU, Relapse, 70% specificity & 90% sensitivity
• It is a mucin, does not  during pregnancy
• Monitor patients who do not express CA 125,
mucinous (76%) > serous (27%)

15. • Human chorionic gonodotropin (βhCG)
• Glycoprotein synthesized by normal placenta
• Serum and urine HCG  in early gestation & peak in
the first trimester (60~90 days)
• Elevated in Gestational trophoblastic disease (a
progressive rise in after 90 days of gestation → highly
suggestive), choriocarcinoma
• Elevated in testicular cancer, βHCG after surgery
• Monitor treatment response, relapse &
recurrence

16. Estrogen Receptor (ER)
• 2 isoforms：ERa and ERb
• ERa → better prognosis, predictor of relapse
• useful when deciding on adjuvant hormone treatment
• As diagnostic marker when it is a primary unknown
tumor
• ERb → Good prognostic factor, correlates with low
grade and negative axillary LN status

17. - To monitor Rx. & to detect recurrence Breast
Cancer
• ↑ in 20% with localized breast cancer, ~80% with
metastatic disease, esp. if with bone involvement
• Specificity of 86%, sensitivity of 30%
• Also ↑ in gastric, pancreatic, cervical & lung cancer
• c-erbB-2 overexpression should be evaluated
on every primary breast cancer either at the
time of diagnosis or at the time of recurrence.

18. •Tyrosinase
• Use RT-PCR to detect hematogenous spread of
melanoma cells from a solid tumor in peripheral
blood
•S100B protein
• For confirmation of amelanotic malignant
melanoma by immunohistology
• ↑in 70% with stage IV metastasized melanoma
•MIA (melanoma inhibitory activity)
• Preoperative: 59% at stage III, 89% at stage IV

19. 1. Alpha fetoprotein antigen (AFP) in hepatoma
2. Carcino-Embryoinic Antigen (CEA) in GI tumors
3. CEA in tumors of biliary system and cancer
breast
4. Cancer Antigen 125 (CA 125) in ovarian carcinoma
5. Cancer Antigen 15-3 (CA15-3) in breast cancer
6. Cancer Antigen 19-9 in colon and pancreatic
tumor
7. Prostatic specific antigen (PSA) - prostatic
tumors

21. Thank you