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Flashcards in Tumor Markers Deck (23):
1

What are tumor markers?

Each marker has a variable profile of usefulness for? 4

1. Glycoprotein molecules in the blood that are detected by monoclonal antibodies

2. Each marker has a variable profile of usefulness for:
-Screening
-Determining diagnosis and prognosis
-Assessing response to therapy
-Monitoring for cancer recurrence

2

1. Where are the tumor markers found? 3

2. How do we utilize these?

1. Found in
-blood,
-urine, or
-body tissue of some patients with cancer

2. Measurements can be useful when used along with x-rays or other test in the detection of some types of cancer

3

1. Tumor Marker function?

2. Elevated levels suggest?

3. At what time are they measured? 3

1. Help detect, diagnose, and manage some types of cancers

2. Elevated levels don’t suggest cancer necessarily

3.
-Measured before treatment to help plan appropriate therapy
-Markers are measured during cancer therapy
-Markers are used to check recurrences

4

Desrcibe the "Ideal Tumor Marker"?
5

“Ideal” Tumor Marker

1. Highly specific
Detectable in only one tumor type

2. Highly sensitive
Non-detectable in physiological or benign disease states

3. Long lead time
Sufficient time for alteration of natural course of the disease

4. Levels correlate with tumor burden

5. In reality no ideal tumor marker exist

5

What are the limitations of tumor markers?
6

1. Elevated marker level may be caused by a condition or disease other than cancer

2. Some maker levels may be high in people without cancer

3. Marker levels may vary over time

4. Almost every one has a small amount of these markers

5. Levels tend to get higher only when a large amount of cancer is present

6. Some people with cancer never have high levels

6

What factors other than the presence of cancer may cause abnormal tumor markers?
4

1. Persons age and
2. gender
3. Which test kit the lab uses
4. How the test is done

7

CA 15-3 and CA 27.29
1. Cancer type?
2. Tissues analyzed?
3. Used how?
4. Found in? 7

1. Cancer type: Breast cancer
2. Tissue analyzed: Blood (MUC1 gene)
3. How used: assess weather treatment is working or disease has recurred
4. Found in:
-colon,
-gastric,
-hepatic,
-lung,
-pancreatic,
-ovarian, and
-prostate cancers

8

CA 15-3 and CA 27.29
Elevation in 1.____ of women with early-stage (I or II) and 2.____ of women with late-stage breast cancer (III or IV)

1. 1/3

2. 2/3

9

CARCINOEMBRYONIC ANTIGEN (CEA)
1. Cancer types? 2

2. Tissue analyzed?

3. Used how? 2

4. Found in? 6

5. Sensitivy increases with what?

6. Not useful for what with colorectal cancer?

7. What is its main role for colorectal cancer?

1. Cancer type:
-Colorectal and
-breast cancer
2. Tissue analyzed: Blood

3. How used:
-Check whether colorectal cancer has spread
-To look for breast cancer recurrence and assess response to treatment

4. Found in:
-breast,
-lung,
-gastric,
-thyroid,
-lymphoma, and
-melanoma

5. Sensitivity increases with advancing tumor stage

6. Not useful in screening for colorectal cancer

7. Role is to follow patients for relapse after intended curative treatment for colorectal cancer

10

What will CEA normals be in smokers and nonsmokers?

Blood
-less than 2.5ng/ml nonsmokers or
-less than 5ng/ml in smokers

11

CANCER ANTIGEN 19-9
CA 19-9
1. Cancer types? 4
2. Tissue? Normal level?
3. Used how?
4. Found in? 3

1. Cancer types:
-Pancreatic,
-Gallbladder,
-Bile duct, and
-Gastric cancer

2. Tissue: Blood (less than 37 units/ml)

3. How used: assess if treatment is working

4. Found in:
-Colon,
-esophageal,
-hepatic cancers

12

1. CA 19-9 role in screening?

2. Levels above _____ units/ml predict presence of metastatic disease

1. No value in screening

2. 1,000

13

ALPHA-FETOPROTEIN (AFP)
1. Cancer types?
2. Tissue? Normal level?
3. Used how? 2
4. FOund in? 3

1. Cancer types:
-Liver and
-Germ cell tumors

2. Tissue: Blood (5.4ng/ml)

3. How used:
-Help diagnose liver cancer and
follows response to treatment, and
-assess stage, prognosis, and response to treatment of germ cell tumors

4. Found in:
-Gastric,
-biliary, and
-pancreatic cancers

14

AFP
1. Abnormal levels in 80% of patients with what?
2. Screening use?

1. hepatocellular cancer

2. Screening under debate

15

BETA-HCG
1. Cancer types? 2
2. Tissue? 2 Normal levels?
3. Used how?
4. Found in?

1. Cancer types:
-Choriocarcinoma and
-testicular cancer

2. Tissue: Urine or blood (less than 5mlU/ml)

3. How used: Asses stage, prognosis, and response to treatment

4. Found in: Gastrointestinal cancers

16

B-HCG
1. Used with ____ for nonseminomatous germ cell tumors

2. Role in screening?

3. At what intervals are these markers followed for response to treatment and check for relapse?

1. AFP

2. Has no role in screening

3. Markers are followed every 1-2 months for a year after treatment, the quarterly for one year

17

CA 125
1. Cancer type?
2. Tissue? Normal levels?
3. Used how?
4. Found in? 6

1. Cancer type: Ovarian cancer

2. Tissue: Blood (less than 35 units/ml)

3. How used: Help diagnose, assessment of response to treatment and evaluations

4. Found in:
-Endometrial,
-fallopian tube,
-breast,
-lung,
-esophageal,
-hepatic,

18

CA 125
1. Elevated most often with what cancer?
2. Screening use?
3. Helps guide what?
4. Levels should be obtained how often?

1. Elevated most often with epithelial ovarian cancer

2. Not a good screening marker

3. Helps guide therapeutic decisions

4. Levels should be obtained every 3 months for 2 years

19

PROSTATE SPECIFIC ANTIGEN (PSA)
1. Cancer types?
2. Tissue? normal levels?
3. Used how?
4. Found in?

1. Cancer type: Prostate Cancer

2. Tissue: Blood (less than 4ng/ml for screening, undetectable after radical prostatectomy)

3. How used: help diagnose, assess response to treatment, and look for recurrence

4. Found in: Prostate

20

PSA levels
1. May return to normal when?
2. What two drugs will lower the PSA and by how much?

3. What velocity is predicative of cancer?

1. PSA levels return to normal 6-8 weeks after symptoms

2. Taking
-Finasteride (Proscar) or
-Dutasteride (Avodart)
for 6 months will decrease PSA in half

3. A velocity of 0.75ng/ml per year or doubling time is predictive of cancer

21

Benign causes of PSA elevation?
3

1. Prostatitis,
2. BPH,
3. after Ejaculation

22

Screening
1. Routine screening in average risk ages ______ not recommended

2. Men ages ______ need discussion about risk and benefits

3. Only marker used to screen for what?

Post Treatment
4. Levels checked how often?
5. A rise in levels after radical prostatectomy suggest what?

1. 40-54

2. 55-69

3. a common type of cancer

4. every six months for 5 years and then annually

5. recurrence

23

PSA patient information and education?
4

Patient information
1. Prostate cancer is common, more patients die with than from

2. Screening detects more organ confined tumors

3. Most instances elevated PSA is not from cancer

4. Localized treatment is effective but has complications (Impotence/Incontinence)