Tumor Markers

Question 1

Tumor Marker Makeup

Answer 1

Proteins produced in response to cancer growth or from cancerous tissue

Can be specific or seen in multiple cancer types

Question 2

Tumor Risk Factors

Answer 2

Genetic mutations

IVDMIA

Question 3

IVDMIA

Answer 3

(in vitro Diagnostic Multivariate Index Assay)

Tests available to detect mutations and offer “risk index”

Question 4

Apoptosis

Answer 4

Programmed cell death, self-destruction

Question 5

Angiogenesis

Answer 5

New blood vessel formation, typically embedded within a tumor, allows tumor cells entry into circulation

Question 6

Benign

Answer 6

Tumor at the primary site, small risk

Question 7

Cancer

Answer 7

Abnormal cell growth, proliferation and/or differentiation

Question 8

Hyperplasia

Answer 8

Multiplication of cells within an organ or tissue, may be controlled by stimuli as a normal response

Question 9

Malignant

Answer 9

Tumor aggressive progress, infiltration, high risk

Question 10

Metastasis

Answer 10

Uncontrolled proliferation involving numerous tumor cells and host cells interactions. Penetration into adjacent tissue of primary site, circulatory system, and spread to distant organs.

Question 11

Neoplasia

Answer 11

Normal cells under cancerous proliferation due to hyperplasia, which is unregulated.

Question 12

Tumor Marker Utilization

Answer 12

• Screening
• Diagnosis
• Staging
• Determine prognosis
• Guidance of Treatment
• Monitor Treatment
• Determine recurrence

Question 13

Tumor Marker Utilization: Screening

Answer 13

Useful for patients with a strong family history of a particular cancer. Example: PSA prostate cancer

Question 14

Tumor Marker Utilization: Diagnosis

Answer 14

In patients with specific clinical symptoms, tumor markers can help identify the source of the cancer and differentiate from other conditions

Examples: CA-125, BRCA1 and BRCA 2

Question 15

Tumor Marker Utilization: Staging

Answer 15

If a patient does have cancer, tumor marker elevations can be used to help determine how far the cancer has spread into other tissues and organs.

Question 16

Tumor Marker Utilization: Determine prognosis

Answer 16

Some tumor markers can be used to help doctors determine how aggressive a cancer is likely to be.

Question 17

Guidance of Treatment

Answer 17

Some tumor markers can provide information about what treatments their patients may have the best response.

Breast cancer patients who are Her2/neu positive are more likely to respond to Herceptin treatment).

Question 18

Monitor Treatment

Answer 18

Tumor markers can be used to monitor the effectiveness of treatment, especially in advanced cancers. If the marker level drops, the treatment is working; if it stays elevated, adjustments are needed.

Colorectal cancer and CEA testing: information must be used with care; not every colorectal cancer patient will have elevated levels of CEA.

Question 19

Determine recurrence

Answer 19

To monitor for cancer recurrence - If a tumor marker is elevated before treatment, low after treatment, and then begins to rise over time, then it is likely that the cancer is returning. (If it remains elevated after surgery, then chances are that not all of the cancer was removed)

Question 20

Tumor Grades

Answer 20

Well differentiated

Poorly differentiated

Anaplastic (without body)

Question 21

Tumor Marker Classifications

Answer 21

Enzymes

Hormones

Oncofetal Infections

Tumor antigens

Genetic Markers

Question 22

Enzymes

Answer 22

Catalytic activity vs mass measurements, detected with Immunoassays

Question 23

Hormones

Answer 23

Immunoassay detection

Question 24

Oncofetal Infections

Answer 24

AFP, CEA, PSA

Question 25

Tumor antigens

Answer 25

CA125, CA15-3, CA19-9

Question 26

Genetic Markers

Answer 26

Oncogene and tumor suppressor mutations

Question 27

Prostate Specific Antigen, level indications

Answer 27

* Enzyme with protease activity in Prostate tissue * Exists in serum as bound (complexed with another protease inhibitor) or free, higher free PSA ratio in normal, healthy patients * Total PSA: 2.6-4ng/mL indicates early development * 4-10mg/mL is diagnostic gray zone * \>10ng/mL have a 50% chance of having cancer

Question 28

hCG (Human Chorionic Gonadotropin)

Answer 28

* Synthesized by trophoblast calls in placenta (used for pregnancy detection), made of 2 Alpha and Beta units * **Beta is specific to hCG** * Increased levels assoc. with **Trophoblastic** tumors, choriocarcinoma, testicular tumors, ovarian tumors * Immunoassay uses **ß-hCG**

Question 29

Oncofetal Proteins

Answer 29

Normally produced in fetal tissues, then decline after birth A rise later in life (60yrs) can indicate cancer formation

Question 30

AFP (Alpha feto protein)

Answer 30

* Marks Liver and Germ cell carcinoma, can also appear in viral hepatitis and chronic active hepatitis * Serum levels correlate to Liver tumor size * During pregnancy increased levels indiacte spina bifida, neural tube defects, and fetal distress; lowered levels indicate Down's Syndrome * Normal adult levels should be lower than 20ng/mL * Found via enzyme immunoassay

Question 31

CEA (carcinoembryonic antigen)

Answer 31

* Marker for colorectal, GI, lung, and breast cancer, found normally in GI of fetus * Not used as a screen as high levels are found in non-cancer patients * Used for therapy monitoring * Immunoassayed using mono/poly/both assay

Question 32

Carbohydrate Tumor Markers

Answer 32

Antigens on tumor cell surface or secreted by the cell Usually more specific when compared to hormone/enzyme markers * CA 125:
 ovarian, endometrial * CA 15-3, CA 549: breast, ovarian * CA 19-9: 
pancreas * CA 19-5:
 GI, pancreas * CA 72-4: Ovarian, breast, GI, colon * CA 50: Pancreas, GI, colon

Question 33

Protein Tumor Markers

Answer 33

* Bence-Jones proteins * C-peptide * Ferritin * Immunoglobulins * Beta2 Microglobulin

Question 34

C-peptide

Answer 34

Insulinoma

Question 35

Ferritin

Answer 35

Liver, lung, breast

Question 36

Immunoglobulins

Answer 36

Multiple myeloma

Question 37

Beta2 Microglobulin

Answer 37

Multiple myeloma, lymphocytic leukemia

Question 38

Oncogenes

Answer 38

Normal genes (code for things like growth factor signals) related to tumor virus genes Their activation is associated with cancer Test for number of copies of genes, Southern blotting, PCR, FISH, Northern blotting, western blotting, ELISA, and immunohistochemistry)

Question 39

HER-2/neu

Answer 39

Transmembrane glycoprotein in epidermal growth factor family Low levels present in breast duct epithelium Over-expressed in ¼ breast cancers Levels predict response to Adriamycin-based chemo., and select patients for anti-HER2/neu Ab, predicts poor response to tamoxifin therapy

Question 40

CA 15-3

Answer 40

* Mucin glycoprotein antigen * Marker for breast cancer recurrance in previously treated patients * increased levels may also be found in Hepatitis, tuberculosis, and SLE

Question 41

CA 125

Answer 41

* Mucin glycoprotein antigen * Marker for ovarian cancer, used to monitor treatment progress

Question 42

CA 19-9

Answer 42

* Glycolipid blood group antigen derived from Lewis Blood Group * Marker for pancreatic, colorectal, lung and gastric carcinomas * Monitors patients progress