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mercy cls 5: chemistry > 23) Tumor markers > Flashcards

23) Tumor markers Flashcards

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1
Q

Molecule may be a product of the malignant tissue, or it may be a substance produced by the body in response to the malignancy

A

tumor marker

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2
Q

Because most tumor markers are molecular forms that exist at some level in normal, benign, and malignant neoplasia, they are not…

A

specific enough to be used as a means of screening an asymptomatic population

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3
Q

t/f tumor markers are diagnostic for cancer

A

false; rarely
PSA is an exception

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4
Q

first tumor marker

A

BJ protein for MM

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5
Q

Alpha-fetoprotein (AFP) used to screen for hepatoma in…

A

a Chinese population that had a high prevalence of that disease

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6
Q

Prostate-specific antigen (PSA) used to screen…

A

men over 50 years

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7
Q

elevated tumor marker may confirm dx if pt has…

A

Signs and symptoms of the disease and risk factors for the disease

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8
Q

Serum levels of tumor markers are widely accepted as useful for…

A

monitoring treatment of diagnosed disease states

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9
Q

3 considerations to make when evaluating utility of tumor markers

A
  1. A single result should not be used to make or confirm a diagnosis.
  2. Values obtained from different manufacturers’ test kits cannot be used interchangeably.
  3. Physiology of the body must be taken into account when evaluating the significance of a tumor marker result.
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10
Q

criteria for an ideal tumor marker

A
  • Easy and inexpensive to measure
  • Specific to the tumor
  • Direct relationship between blood levels of the marker and tumor mass
  • Abnormal plasma level, urine level, or both
  • Levels that are stable and not subject to aberrant fluctuations.
  • If the tumor marker is present in plasma of healthy individuals, it should exist at a much lower concentration than that found in association with all stages of cancer.
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11
Q

Measure of how often the assay system detects the biomarker when the disease is present

A

sensitivity

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12
Q

Used to describe the probability that a laboratory test will be negative in the absence of disease

A

specificity

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13
Q

the probability that a disease is present when the test is positive or that a disease is absent when a test is negative.

A

predictive value

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14
Q

positive predictive value =

A

100(TP)/(TP + FP)

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15
Q

negative predictive value =

A

100(TN)/(TN + FN)

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16
Q

sensitivity =

A

100(TP)/(TP + FN)

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17
Q

specificity =

A

100(TN)/(TN + FP)

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18
Q

A measure of how often the assay system detects the biomarker when the disease is present

A

diagnostic sensitivity

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19
Q

The probability that a lab test will be negative in the absence of disease

A

diagnostic specificity

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20
Q

combining multiple modes of genomic analysis: gene- and exon-level expression, DNA variation, and copy number data to fundamentally improve our understanding of the disease

A

microarrays for cancer detection

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21
Q

Prior to 1950s, —— were the only tumor markers available

A

enzymes

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22
Q

alk phos sources

A

Liver, bone, intestine, and placenta

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23
Q

normal increased levels of alk phos

A

pregnant women
growing children

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24
Q

help differentiate source of elevated ALP

A

5’-nucleotidase
γ-glutamyl transferase (GGT)
ALP isoenzymes

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25
Q

Dimer consisting of 2 subunits: M and B and 3 isoenzymes

A

creatine kinase

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26
Q

CK-1 is elevated in…

A

small cell carcinoma of the lung
prostate cancer

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27
Q

Nonspecific, but elevated in liver, non-Hodgkin’s lymphoma, acute leukemia, nonseminomatous germ cell testicular cancer, seminoma, neuroblastoma, and others.

A

lactate dehydrogenase

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28
Q

It is a glycoprotein hormone secreted by the syncytiotrophoblastic cells of the normal placenta and consists of 2 subunits

A

B HCG

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29
Q

2 hCG subunits

A
  • Alpha: Common to several other hormones including LH, FSH, and TSH
  • Beta: Unique to hCG, and the 28-30 amino acids located on the carboxyl terminus are antigenically unique
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30
Q

the free ß-subunit is produced together with intact or whole hCG

A

early pregnancy

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31
Q

useful in detecting trophoblastic tumors and together with AFP to detect of nonseminomatous testicular tumors.

A

B hCG

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32
Q

For ——– tumors, you would need to test for total β -hCG

A

testicular

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33
Q

Can be used to screen for choriocarcinoma (rare cancer of the uterus) in women who are at high risk for the disease

A

B hCG

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34
Q

A clinically useful application is for monitoring the treatment and progression of trophoblastic disease

A

B hCG

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35
Q

Extremely high initial ß-hCG levels (>200,000-400,000 U/L) are considered to…

A

put patients at high risk for treatment failure.

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36
Q

“Total hCG” assays measures both…

A

the intact hCG and free ß-subunits

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37
Q

Hormone produced by the C-cells of the thyroid

A

calcitonin

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38
Q

Calcitonin normally secreted in response to an ——— in serum calcium from bone, thereby ——— the serum calcium level

A

increase
lowering

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39
Q

Patients with familial medullary carcinoma of the thyroid, an autosomal dominant disorder, will present with elevated …

A

calcitonin

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40
Q

Elevated in benign conditions: pulmonary diseases, pancreatitis, hypertension, pernicious anemia, Paget’s bone disease, and pregnancy.

A

calcitonin

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41
Q

Patients with small cell carcinoma (SCC) of the lung may produce ——- in significant quantity.

A

ProACTH

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42
Q

Produced by the fetal yolk sac and fetal hepatocytes

Levels rapidly decline at birth and healthy kids and adults have negligible or undetectable levels

A

AFP

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43
Q

Elevated in patients with hepatocellular carcinoma

A

AFP

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44
Q

Measuring both —– and —– can be useful in classifying and staging germ cell tumors.

A

AFP and hCG

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45
Q

AFP and hCG

  • Yolk sac tumors
  • Choriocarcinoma
  • Embryonal carcinoma
  • Teratoma
A
  • ↑ AFP
  • ↑ hCG
  • ↑ both
  • both normal
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46
Q

Neural tube defect screening includes ——- in the second trimester from the maternal serum

A

AFP

47
Q

During pregnancy, maternal AFP levels increase from —– weeks of gestation to a peak of about —– mg/L during the third trimester.

The fetal AFP reaches a peak of —– mg/L at 14 weeks and then declines to about —– mg/dL at term.

A

12
500
1000
70

48
Q

leading causes of cancer in men

A
  1. skin
  2. prostate
49
Q

Also referred to as human kallikrein 3 (hK3)

A

PSA

50
Q

Serine protease consisting of 237 amino acid residues and 4 carbohydrate side chains

A

PSA

51
Q

In seminal fluid, 60-70% as free PSA and <5% is complexed with protease inhibitors such as…

A

protein C inhibitor (PCI)

52
Q

In blood, 55-95% of immune detectable PSA is bound to ——- and 5-45% of immune detectable PSA is free

A

α1-antichymotrypsin (ACT)

53
Q

α1-antichymotrypsin (ACT)
Protein C inhibitor (PCI)
α1-proteinase inhibitor (API)
α2-macroglobulin (AMG)

A

form stable 1:1 complexes with PSA in serum

54
Q

Measuring serum biomarkers for early detection of ——- cancer is a highly controversial topic in medicine

A

prostate

55
Q

PSA testing by itself is not effective in the screening or detection of early prostate cancer because…

A

PSA is specific for prostate tissue, but not for prostate cancer

56
Q

high PSA; benign condition

A

Benign Prostate Hypertrophy (BPH)

57
Q

A widely used cutoff value representing low risk of disease for tPSA is —— ng/mL.

A

≤ 4.0

58
Q

great likelihood of prostate cancer

A

PSA >10 ng/mL

59
Q

% fPSA =

A

100(fPSA)/tPSA

60
Q

% fPSA ——– detected 95% of prostate cancer when the tPSA is between 4 and 10 ng/mL

A

≤ 25%

61
Q

advantage to complex PSA assay

A

minimal effect on the levels of cPSA after prostate manipulation either by flexible cystoscopy or digital rectal examination (DRE)

62
Q

Most cPSA assays measure only…

A

PSA-ACT

63
Q

The amount of —————- found in seminal fluid is about 100,000 fold higher than in serum

A

Human glandular kallikrein 2 (hK2)

64
Q

Measuring serum ——— alone or in combination with tPSA/fPSA has been shown to be a significantly better predictor of organ-confined prostate cancer

A

hK2

65
Q

May be better as detecting prostate cancer and reducing the number of unnecessary biopsies than fPSA

Useful when tPSA is in the range of 2.5-4.0 ng/mL

A

ProPSA

66
Q

Primary form of proPSA found in tumor extracts

A

(-2) ProPSA.

67
Q

encodes an mRNA elevated in prostate cancer

elevated urine levels increase diagnostic specificity

A

PCA3

68
Q

PCA3 cutoff value

A

35
(increased likelyhood for positive biopsy)

69
Q

Useful for early detection of prostate cancer

A

Early prostate cancer antigen-2 (EPCA-2)

70
Q

CA 15-3

A

most widely used for breast cancer

71
Q

Used for monitoring therapy for advanced or recurrent breast cancer

A

CA 15-3

72
Q

Breast cancer oncogene identified as a transmembrane protein of the tyrosine kinase receptor family

A

Human epidermal growth factor receptor 2 (HER-2/neu)

Neu portion refers to its association with neural tumors

73
Q

A useful prognostic indicator of overall survival in patients with breast cancer

A

Human epidermal growth factor receptor 2 (HER-2/neu)

74
Q

humanized monoclonal AB against HER-2/neu receptors

A

Herceptin® (trastuzumab)

75
Q

genes that predispose pt to develop breast and ovarian cancer because of an autosomal dominant trait

A

BRCA1 and BRCA2

76
Q

Women who carry ——- mutations have a lifetime risk of breast cancer that ranges from 56-87% as well as an increased risk for developing ovarian cancer

A

BRCA1

77
Q

Men with ———– mutations are at risk for male breast cancer and may also have an increased risk for developing various types of cancers including prostate, melanoma, and pancreatic

A

BRCA1 or BRCA2

78
Q

It is a useful marker for recurrence of breast cancer in patients after initial therapy followed by adjuvant therapy

A

CA 549

79
Q

NOT useful in detecting early breast cancer because of the high proportion of women with breast cancer having low levels

A

CA 549

80
Q

detected by a monoclonal antibody is produced against an antigen in ascites fluid of patients with metastatic breast cancer.

A

CA 27.29

81
Q

Useful in checking for recurrence with stage II or stage III breast cancer.

A

CA 27.29

82
Q

Approximately 90% of ovarian cancers are ——- tumors.

A

epithelial

83
Q

most common cause of cancer death from gynecologic tumors in the United States

A

ovarian cancer

84
Q

Expressed by epithelial ovarian tumors and other pathological and normal tissues of mulerian duct origin

A

CA 125

85
Q

Most useful for epithelial ovarian cancer (EOC) and endometrial carcinomas

A

CA 125

86
Q

EosinophI-derived neurotoxin (EDN)
COOH-terminal osteopontin fragments

A

Correlates with ovarian cancer

87
Q

cytokines IL-6, IL-8, vascular endothelial growth factor (VEGF), epidermal growth factor (EGF)

A

ovarian cancer

88
Q

hK5, hK10, and hK11

A

kallikreins associated with ovarian cancer

89
Q

Plasmenyl Phosphatidic acid (PPA)
Plasmenyl Ethanolamine (PPE)

A

plasmalogens associated with ovarian cancer

90
Q

Elevated levels of ——— were found in ascites of ovarian cancer patients but also in the corresponding plasma samples

A

Lysophosphatidic acid (LPA)

91
Q

One of the easiest and simplest tests to perform for detecting colorectal cancer in the early stages, particularly for people older than age 50

A

fecal occult blood

92
Q

found in embryonic tissue and elevated in colorectal cancer

A

Carcinoembryonic antigen (CEA)

93
Q

CEA function

A

monitor therapy and detecting recurrence of colon cancer

NOT for screening

94
Q

Expressed in the brush border membrane of intestinal mucosal cells

Associtaed with colon cancer

A

Guanylyl Cyclase C (GC-C)

95
Q

Whole blood GCC-B1 test method

A

PCR

96
Q

CA 19-9
CA 50
CA 242

A

pancreatic cancer markers

97
Q

Glycoprotein that is a sialylated derivative of the Lea blood group antigen

A

CA 19-9

98
Q

May be a good predictor of prognosis in pancreatic cancer

A

CA 19-9

99
Q

Also known as gastrointestinal cancer-associated antigen (GICA)

A

CA 19-9

100
Q

Monoclonal antibody developed against the human colonic adenocarcinoma cell line COLO 205.

A

CA 50

101
Q

Has a higher percentage elevation in colorectal cancer than CA 50 and CA 19-9.

A

CA 242

102
Q

most common type of bladder cancer

A

transitional cell carcinoma (TCC)

103
Q

Can be found in urine due to invasion of the basement membrane by tumors or production by the tumor itself or a combination of these processes.

A

Bladder tumor antigen (BTA)

104
Q

part of the internal structural framework of the nuclei of cells in the bladder

A

Nuclear matrix proteins (NMP)

105
Q

Has been recommended for the differential diagnosis of small cell lung cancer

A

Neuron-Specific Enolase (NSE)

106
Q

Can provide useful information in diagnosing non-small cell lung carcinoma (NSCLC).

Most sensitive biomarker in NSCLS, particularly small cell carcinoma (SCC).

A

CYFRA 21-1

107
Q

intermediate filament keratins found in the intracytoplasmic cytoskeleton of epithelial tissue

A

Cytokeratins

elevated in lung cancer

108
Q

may be used in the differential diagnosis of NSCLC, especially when used in combination with CYFRA 21-1 and CEA

A

Small Cell Carcinoma Antigen (SCCA)

109
Q

Most potentially useful biomarker for gastric cancer

A

CA 72-4

110
Q

Used to diagnose gastric cancer and monitor immunotherapy

A

CA 72-4 or Tumor-associated glycoprotein (TAG-22)

111
Q

sensitivity of 41% in gastric cancer patients

A

B hCG

112
Q

combinations of…
C A 242
C A 125
C A 15-3
C A 19-9

can help diagnose…

A

gallbladder cancer

113
Q

disease is present
need true positives and false negatives

A

sensitivity

114
Q

disease is absent
need true negatives and false positives

A

specificity

mercy cls 5: chemistry (24 decks)

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