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Flashcards in Lab Assessment of Tumor Markers Deck (14)
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1

What are the clinical utilities for tumor markers?

screening
early detection
differential diagnosis in symptomatic patients
clinical staging
estimating tumor volume
prognosis
predicting of treatment response
monitoring of therapy
detecting of cancer recurrence

2

How would you interpret the following results: Total PSA 5.2, % free PSA 28%

PSA is elevated

then use the %free PSA to determine the probability of cancer. The higher the percent PSA, the LESS likely it's cancerous. >25% free has only an 8% probability of cancer

(note, only check this if the PSA is between 4 and 10. if it's over 10, the risk of cancer is already over 50%)

3

What are some pre-analytical factors that affect tthe PSA?

biological variation
prostate manipulation (DRE, needle biopsy, ejactulation)
exercise (esp biking)
prostatitis
drugs (finasteride)

4

What is the intended use of the PCA3 assay?

to aid in clinical decisions for when to re-biopsy patients who were previously biopsy-negative for prostate cancer

BUT - recommendations are currently against use even though it's FDA approved

5

Describe the high dose hook (prozone) effect?

If you have an excess amount of antigen binding to either the capture or labeled antibody of a lab test, then you don't get the desired "sandwich" complex and the result will be lower than anticipated

6

How can you identify if a high dose hook effect has occurred?

you assay the same specimen at two dilutions. If the result is higher at the lower dilution, then you know the effect is occurring

7

What is the intended use for CA125?

It's indicated as a ONE-TIME test for use as an aid in the detection of residual ovarian Ca after first-line therapy

helps to decide if you need a second-look procedure

8

A CA125 assay value greater than what is indicative of residual disease?

35 U/mL

(provided that alternative causes of an elevated CA125 can be excluded)

9

What are some non-cancer conditions that will elevate the CA125?

menstruation
first trimester of pregnancy
CHF
TB
Cirrhosis
Fibroids
Benign ovarian tumors
Endometriosis

10

What are some non-gynecological cancers that will elevate the CA125?

liver Ca
Lung ca
Breast Ca
Pancreatic Ca

11

What marker can be used to monitor recurrence or progressive disease in patients with epithelial ovarian cancer?

human epididymis protein 4 (HE4)

12

WHy is HE4 particularly useful?

It is more specific to cancer than CA125, so you can use it when the patient has a re-elevation of CA125 and you want to assess for cancer recurrence

13

What algorithm utilizes both the HE4 and CA125?

the Risk of Ovarian Malignancy Algorithm (ROMA)

14

OVA1 is another lab algorithm that can be used to further assess the likelihood of malignancy. What labs go into this?

CA125 + Prealbumin + Apolipoprotein A-1 + Beta2- microglobulin + Transferrin