Laboratory dignosis Flashcards
(35 cards)
Tumor markers: classification
o Enzymes o Tissue receptors o Oncogenes o Hormones o Antigens (largest class)
Tumor markers: enzymes
In certain tissues are found in blood plasma at higher levels when the cancer involves that tissue
(PAP- prostatic acid phosphatase)
Tumor markers: Tissue receptors
Proteins associated with the cell membrane.
Bind to hormones and growth factors, and therefore affect the rate of tumor growth.
May be measured in the blood, extracellular fluid, and tissue samples after biopsy
(E and P receptors)
Tumor markers: Oncogenes
Some tumor markers are the product of oncogenes, which are genes that are active in fetal development and trigger the growth of tumors when they are activated in mature cells
(BARC1/2)
Tumor markers: Hormones
- hormones that are normally secreted by the tissue in which the malignancy arises
- hormones produced by tissues that do not normally produce it
(ACTH ectopic production)
Tumor markers: Antigens
Largest class of tumor marker ➢ Oncofetal antigens (AFP) (protein that are present only in fetal development and in adult life in cancer)
➢ Carbohydrate antigens (Ca 15-3)
➢ Blood group antigens (Ca 19-9)
Tumor markers:
Factors that influence the quality of results
- High specifity, i.e. not detectable in benign diseases and healthy subjects (has no false positives);
- High sensitivity, i.e. detectable very early when only a few cancer cells are present (has no false negatives);
- Organ specificity (PSA);
- Correlation with the tumor stage or tumor mass;
- Responsible to treatment;
- Correlation with prognosis;
- Reliable prediction value.
Tumor markers: criteria (7)
- High specifity, i.e. not detectable in benign diseases and healthy subjects (has no false positives);
- High sensitivity, i.e. detectable very early when only a few cancer cells are present (has no false negatives);
- Organ specificity (PSA);
- Correlation with the tumor stage or tumor mass;
- Responsible to treatment;
- Correlation with prognosis;
- Reliable prediction value.
Tumor markers: Clinical use
To detect the tumor localization, size, course of development..
GI tumor markers: (3)
Liver (3)
- AFP
- AFP-L3%
Pancreas (4)
- Ca 19-9,
- CEA,
- Ca494,
- Ca242
Colorectal (3)
- CEA,
- CTC,
- Ca 19-9
Stomach (2)
- CEA,
- Ca 72-4
GI tumor markers, clinical significance. Interpretation of results.
LIVER (3)
AFP: ▪ Useful in diagnosing cancer and in monitoring its treatment, determine prognosis or detecting tumor recurrence. ▪ Detect liver cancer at early stage. ▪ Hepatocellular carcinoma. ▪ Germ cells tumors. ▪ Chronic hepatitis.
AFP-L3:
▪ New generation TM.
▪ Specific for liver cancer (hepatocellular carcinoma)
▪ Used for screening
▪ Found to be useful indicator of distant metastasis and poor prognosis for HCC.
AFP-L3%:
▪ Very specific for small HCC.
▪ AFP-L3%>35%- 100% specificity for HCC.
Gastrointestinal tumor markers, clinical significance. Interpretation of results.
PANCREAS (2)
Ca 19-9:
▪ Not used for screening
▪ Pancreatic cancer and hepatobilliary carcinoma.
▪ Is useful in monitoring recurrence or early relapse.
Carcinoembryionic antigen (CEA):
▪ Non-specific.
▪ Not used for screening.
▪ Used for monitoring of the treatment response and reoccurrence.
▪ Colorectal cancer
▪ Pancreatic carcinoma
▪ Gastric carcinoma
▪ Lung carcinoma.
Gastrointestinal tumor markers, clinical significance. Interpretation of results.
COLORECTAL (1)
Carcinoembryionic antigen (CEA): ▪ Non-specific. ▪ Not used for screening. ▪ Used for monitoring of the treatment response and reoccurrence. ▪ Colorectal cancer ▪ Pancreatic carcinoma ▪ Gastric carcinoma ▪ Lung carcinoma.
Gastrointestinal tumor markers, clinical significance. Interpretation of results.
STOMACH (1)
Carcinoembryionic antigen (CEA): ▪ Non-specific. ▪ Not used for screening. ▪ Used for monitoring of the treatment response and reoccurrence. ▪ Colorectal cancer ▪ Pancreatic carcinoma ▪ Gastric carcinoma ▪ Lung carcinoma.
Genitourinary tract tumor markers
PROSTATE (7)
- PSA
- fPSA
- CTC
- PAP
- PSMA
- PCA3
- EPCA-2
Genitourinary tract tumor markers
TESTICULAR GERM CELL (5)
- hCG,
- fßHCG
- AFP
- LDH
- PAP
Genitourinary tract tumor markers
URINARY BLADDER (7)
- NMP22
- BTA
- CEA
- Ca 125
- Ca 19-9
- TPA
- p53
Genitourinary tract tumor markers, clinical significance. Interpretation of results.
PROSTATE (6)
➢ PSA-
▪ Used for screening, follow up and monitor of treatment.
▪ Race depended.
▪ To avoid false results- preform with rectal examination and biopsy
▪ May be elevated after ejaculation.
▪ Prostatic cancer
▪ Metastasis from prostatic cancer.
➢ fPSA/PSA:
▪ >25% not prostate cancer.
▪
Genitourinary tract tumor markers, clinical significance. Interpretation of results.
TESTICULAR GERM CELL (2)
Seminomatuos/ non-seminomatuos:
- non-seminomatuos grow faster
- early onset of cancer
- lower survival rate
➢ ßHCG:
▪ Increase in seminoma with no increase in AFP.
▪ Better TM then hCG.
▪ Never found in normal men.
▪ Testicular cancer.
▪ The amount correlate with tumor mass.
▪ Used in- diagnosis, staging, management and detection of reoccurrence
➢ AFP:
▪ Elevated in non- seminoma cancer with or without ßHCG
Genitourinary tract tumor markers, clinical significance. Interpretation of results.
URINARY BLADDER (3)
➢ Nuclear matrix protein (NMP22):
▪ + in 70% of bladder carcinoma.
▪ Not used for screening.
▪ Used for follow ups.
➢ Bladder tumor antigen (BTA):
▪ Elevated in urine in bladder tumors.
▪ High in kidney stones and UTI.
➢ Tissue polypeptide antigen (TPA):
▪ Marker of proliferation and to specific for tumors.
▪ Used for follow up.
▪ Bladder, breast, bronchial, cervical, ovarian and colorectal carcinoma.
Gynecological tumor markers: (3)
Ovarian carcinoma: (9) -Ca 125, -Ca 72-4, -LASA-P, -CEA, -TPA, -BRCA1, -BRCA2, -HE4, -SMRP Ovarian germ cells: (2) -hCG -AFP Gestational trophoblastic disease: (1) -hCG
Gynecological tumor markers: clinical significance. Interpretation of results.
OVARIAN (5)
➢ Ca 125:
▪ Not used as screening test.
▪ Endometrial, uterine tube and lung malignancies.
▪ Most used serum biomarker.
▪ Used for diagnosis, response to treatment and reoccurrence.
▪ Have high rate of false positive
➢ Human epididymis protein 4 (HE4):
▪ New biomarker for early diagnosis.
▪ High sensitivity and specificity.
➢ Mesothelin (SMRP):
▪ In combination with HE4 is god early diagnosis.
▪ Complimentary diagnostic tool with Ca 125.
▪ Detected in other body fluids not just blood.
▪ Ovarian cancer, pancreatic adenocarcinoma, mesotelioma.
➢ Ca 72-4:
▪ Detects stomach carcinoma
▪ If combined with Ca125- detects ovarian carcinoma.
➢ BRCA-1/2:
▪ Genetic marker.
▪ Human suppressor genes.
Gynecological tumor markers: clinical significance. Interpretation of results.
OVARIAN GERM CELLS (2)
Can be cancerous or non.
Birth defect.
➢ hCG:
▪produced in the placenta
▪ Germ cells tumors
▪ Choriocarcinomas
▪ Gestational trophoblastic disease.
▪ Correlates with staging and tumor mass.
▪ Have little clinical application in- breast, lung, prostate, kidney, pancreatic, bladder and gastrointestinal tract cancers
➢ BhCG:
▪ Better then hCG.
▪ Used in diagnosis and monitoring.
▪ False positive in vegetarians
▪ False negative due to drugs and fluids.
▪ Increased in- duodenal ulcer, cirrhosis, pregnancy.
Gynecological tumor markers: clinical significance. Interpretation of results.
GESTATIONAL THROMBOPLASTIC D. (1)
➢ hCG:
▪produced in the placenta
▪ Germ cells tumors
▪ Choriocarcinomas
▪ Gestational trophoblastic disease.
▪ Correlates with staging and tumor mass.
▪ Have little clinical application in- breast, lung, prostate, kidney, pancreatic, bladder and gastrointestinal tract cancers
