Tumour Markers Flashcards by Iseoluwa Ojo

Cancer
—______ growth of cells that can develop into a ______ or _____ and spread to other areas of the body.

Uncontrolled

solid mass or tumor

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Tumorigenesis: ________ of ______

Metastasis-_____ of _______

Formation of tumors

Spreading of tumors

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Oncofetal

Expressed during __________, then reexpressed in ________

the development of the fetus

tumors

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Sensitivity

The likelihood that given the presence of disease, a test result ______________.

No ________

predicts the presence of the disease

false negatives.

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Specificity

The likelihood that given the absence of disease, a test result ____________

No _________

excludes the presence of disease

false positives

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A Tumour marker Is Produced by ______ or as an effect of __________

the tumor

the tumor on healthy tissue

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A Tumour marker

Concentration ___eases with tumor progression

highest levels when ____________

Include diverse molecules such as serum ________,________ antigens, hormones, metabolites, receptors and enzymes

Incr

tumors metastasize

proteins; oncofetal

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Tumor Marker Detection:

Ideally, a tumor marker would be:

A substance that is released (directly or indirectly?) into the _______ detectable at _____ concentrations

Tumor specific ( [high or low?} specificity)

(Present or absent?) in healthy individuals

readily detectable in body fluids.

Directly ; bloodstream

small a

High

Absent

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Mention 2 ideal tumour markers that tick all the boxes

Unfortunately, no tumour marker fits this ideal model.

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Application of tumor markers

_______ populations at risk

______ : Use results from markers, imaging, risk factors, and symptoms

Prognosis: ________ of the marker determines prognosis

Screening

Diagnosis

Concentration

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all tumor markers are good screening tools

T/F

Not all

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Application of tumor markers

Detection of ________: Once tumor is removed, elevations of marker can indicate ______

Monitoring ________: ____eased levels of tumor marker indicate therapy is working
____eased levels of tumor marker may indicate need for a change to therapy

recurrence; regrowth

response to treatment

Decr
Incr

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Most commonly used method of tumors marker detection?

Immunoassay

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Immunoassay
Challenges:

•Markers are often above_____

•Hook effect: excessive ____ marker concentrations result in ______

•Heterophile Antibodies
–Interfere with testing due to the presence of __________

•________,_______ and _______ cause interferences

linearity; high; false lows

circulating antibodies against animal immunoglobulin

Lipemia, hemolysis and antibody cross reactivity

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Tumor markers: Enzymes

Increase due to ________ of cells
Indicate tumor ______

Examples
__________- Bone, liver, intestine

________- Prostate, lung, breast, colon, ovarian

__________-Liver, lymphomas, leukemias

___________-Prostate

metabolic demands; burden

Alkaline phosphatase

Creatine kinase

Lactate dehydrogenase

Prostatic acid phosphatase

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Alkaline phosphatase(ALP):

Increased ALP activities are seen in primary or secondary ____ cancer. It’s level may be helpful in evaluating ___________ with _____ or ____ involvement.

liver

metastatic cancer with bone or liver

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Placental ALP, a ____________ elevates in a variety of malignancies including _____,______,______cancers and _____ disease

regan isoenzyme

ovarian, lung, GI

Hodgkin’s

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Prostatic acid phosphatase (PAP)

It is used for staging ____ cancer and for monitoring therapy. Increased PAP activity may be seen in _______,______, and ____ metastasis of other cancers and in some benign conditions such as ________ and _______.

prostate

osteogenic sarcoma, multiple myeloma and bone

osteoporosis and hyperparathyroidism

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Prostate Specific Antigen (PSA)
– The clinical use of ____ has been replaced by PSA. PSA is much (more or less?) specific for screening or for detection early cancer. It is found in mainly ______ tissue.

PAP

Prostatic

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PSA exists in two major forms in blood circulation.
The majority of PSA is _______________.

A minor component of PSA is ____.

complexed with some proteins

free

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PSA testing itself is effective in detecting early prostate cancer.

PSA testing itself is not effective in detecting early prostate cancer.

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Other prostatic diseases, urinary bladder ________ and ______ examination may lead an increased ______ in serum.

cateterization

digital rectal

PSA level

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The ratio between ____ and ____ PSA is an reliable marker for differentiation of ________ from _______

free and total

prostatic cancer from benign prostatic hyperplasia.

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The use of PSA should be together with __________ and followed by ________ for an accurate diagnosis of cancer.

digital rectal examination

transrectal ultrasonography

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The greatest clinical use of PSA is in the __________ which includes ________,_______, and __________ therapy.

monitoring of treatment. radical prostatectomy, radiation therapy and antiandrogen

After treatment, The PSA level should fall below the detection limit. This may require ________. If PSA still at high level after that, it must be assumed that _________________

2-3 weeks residual tumor is present.

______________ treatment may have direct effect on the PSA level that is independent of the antitumor effect. This subject must be considered always

Androgen deprivation therapy

Tumor markers: Endocrine/ hormones Helpful in identification of: _________ ______ tumor ______ tumor Examples Beta-human chorionic gonadotropin Calcitonin Adrenocorticotropin hormone (ACTH)

Choriocarcinoma Pituitary Adrenal

Calcitonin – Calcitonin is a hormone which ____eases blood calcium concentration. – Its elevated level is usually associated with _________ cancer.

decr medullary thyroid

Calcitonin levels correlates with tumor volume and metastasis. T/F

Calcitonin is also useful for monitoring treatment and detecting the recurrence of cancer. T/F

However calcitonin levels are also at a high levels in some patients with cancer of ____,______,_____, and _____ and in nonmalignant conditions such as ____ diseases, ____itis, _____ disease, hyperparathyroidism, myeloproliferative disordes and pregnancy.

lung, breast, kidney, liver pulmonary; pancreat; Paget’s

Human Chorionic Gonadotropin (hCG) –Hormone normally secreted by the ______ to _______ – Molecule consists of two subunits: ____ and ____ – Elevated in ______ tumors, _______ and _______ tumors of the ovary and testis – Most immunoassays detect either the subunits or the total molecule

placenta; maintain pregnancy alpha & beta trophoblastic; choriocarcinoma; germ cell

Tumor markers: Oncofetal antigens Become ______ in tumor formation Examples –______________ –____________

detectable Carcino-embryonic antigen(CEA) Alpha-fetoprotein

Oncofetal antigens are Considered normal in fetal development T/F

Frequently Ordered Tumor Markers Carcinoembryonic Antigen (CEA) Expressed during ________ then re-expressed in _______ Clinical use Used to detect colorectal, lung, breast ovarian, and GI cancers Monitor therapy

fetal development ; tumor growth

Carcinoembryonic antigen (CEA) – It is a ______ protein – CEA is a marker for ___, gastrointestinal, lung and breast carcinoma. – CEA levels are also elevated in ____ and some patients having benign conditions such as _____,_____,______ and _____ disease.

cell-surface colorectal smokers cirrhosis, rectal polips, ulcerative colitis and benign breast

Carcinoembryonic antigen (CEA) is a well defined tumor marker. T/F

CEA testing should be used for screening. T/F With reason

F CEA testing should not be used for screening Some tumors don’t produce CEA.

CEA testing should be used for ______ and _____

staging and monitoring therapy.

Frequently Ordered Tumor Markers Alpha(α) Fetoprotein (AFP) – Synthesized by the _____ – Re-expressed in certain types of tumors – Normally functions as a ______ and helps to regulate ___________ in the ______ – Used to diagnose _______ carcinoma and ______ tumors (testes, ovaries)

fetal liver transport protein oncotic pressure in the fetus hepatocellular; germ cell

AFP is useful for screening T/F

AFP levels greater than _____ μg/L are indicative for cancer except pregnancy

1000

AFP can be useful in determining prognosis and monitoring therapy of liver cancers T/F

AFP is also a prognostic indicator of survival. T/F

Serum AFP levels is less than ___ μg/L in healthy adults.

Elevated AFP levels are associated with (shorter or longer?) survival time.

Shorter

___________ combined are useful in classifying and staging germ cell tumors.One or both markers are increased in those tumors.

AFP and hCG

Carbohydrate markers These markers either are antigens on the ________ or are ________

tumor cell surface secreted by tumor cells.

Carbohydrate markers They are (low or high?)-molecular weight _____ or ________. ____________ have been developed against these antigens.

High ; mucins blood group antigens Monoclonal antibodies

Carbohydrate markers Most reliable markers in this group are CA ____, CA ___ and CA _______

15- 3 125 19-9.

CA 15-3 – CA 15-3 is a marker for ____ carcinoma. Elevated CA 15-3 levels are also found in patients with pancreatic, lung, ovarian, colorectal and liver cancer and in some benign breast and liver diseases.

breast

CA-15-3 is useful for diagnosis.

F It is not useful for diagnosis.

CA-15-3 is most useful for monitoring therapy. T/F

CA 125 – Although CA 125 is a marker for _____ and ______ carcinomas -CA 125 can be elevated in pancreatic, lung, breast, colorectal and GI cancers, and in benign conditions such as cirrhosis, hepatitis, endometriosis, pericarditis and early pregnancy.

ovarian and endometrial

CA 125 is specific. T/F

F it is not specific.

CA 125 is useful in detecting ______________________

residual disease in cancer patients following initial therapy.

CA 125 is also useful in differentiating benign from malignant disease in patients with ___________

ovarian masses.

In the detection of recurrence, use of CA 125 level as an indicator is about ___ % accurate.

CA 19-9 – CA 19-9 is a marker for both ———- and ———- carcinoma.However elevated levels were seen in patients with hepatobiliary, gastric,hepatocellular and breast cancer and in benign conditions such as pancreatitis and benign gastrointestinal diseases.

colorectal and pancreatic

CA 19-9 levels correlate with pancreatic cancer staging T/F.

CA 19-9 levels is useful in monitoring pancreatic and colorectal cancer. T/F

Elevated levels of CA 19-9 can be indicative of _____ before detected by radiography or clinical findings in ______ and _________ cancer.

recurrence pancreatic and colorectal

CA 15-3 = CA 125= CA 19.9=

Breast Ovarian, endometrial Colorectal, pancreatic

PROTEIN MARKERS Most reliable markers in this group are _______ ,______,______,______

β2- microglobulin, ferritin, thyroglobulin and immunoglobulin.

β2-microglobulin β2-microglobulin is a marker for ______,________ . It also increases in ___ inflammation and viral ______.

multiple myeloma, Hodgkin lymphoma chronic; hepatitis

Ferritin – Ferritin is a marker for ____, _____ , liver, lung and breast cancer.

Hodgkin lymphoma leukemia

Thyroglobulin – It is a useful marker for detection of _____ cancer.

Differentiated thyroid

Immunoglobulin: – Monoclonal immunoglobulin has been used as marker for ________ for more than 100 years.

multiple myeloma

Monoclonal paraproteins appear as _______ in the globulin area of the serum protein electrophoresis.

sharp bands

Bence-Jones protein is a ________________________ in the _____ and it is a reliable marker for multiple myeloma.

free monoclonal immunoglobulin light chain urine

RECEPTOR MARKERS Estrogen and progesterone receptors are used in _____ cancer as indicators for __________

breast hormonal therapy.

Patients with ______ estrogen and progesterone receptors tend to respond to hormonal treatment. Those with _______ receptors can be treated by other treatment modalities.

positive negative

Hormone receptors also serve as a prognostic factors in breast cancer. T/F

Hormone receptors also serve as a prognostic factors in breast cancer. Patients with ______ receptor levels tend to survive longer.

positive

Cytoplasmic estrogen receptors are now routinely measured in samples of breast tissue after surgial removal of a tumor. T/F

Of patients with breast cancer, ___ % have tumors with estrogen receptor.

Approximately _____ of patients with estrogen receptor (+) tumors respond to the hormonal therapy. ___% of patients with estrogen receptor (-) tumors respond to the hormonal therapy.

two thirds 5

________ receptor testing is a useful adjunt to the estrogen receptor testing. Because ______ receptor synthesis appears to be (independent or dependent?) on estrogen action.

Progesterone progesterone

Measurement of progesterone receptors provides a confirmation that _____________. Indeed breast cancer patients with both progesterone and estrogen receptor (+) tumors have a (higher or lower?) response rate to hormonal therapy

all the steps of estrogen action are intact higher

Tumor markers can be used to confirm diagnosis T/F

F Tumor markers can never be used to confirm diagnosis

Tumor markers can be used to _______ diagnosis

Support

Reference value for prostatic specific antigen ?

0-4ng/mL

Levels of PSA greater than ___ng/ml strongly suggest cancer

(Majority or minority?) of PSA is bound to plasma proteins (Majority or minority?) is free

Majority Minority

CA _____ is a carcinoembryonic antigen

19-9

Tumour Markers Flashcards

(86 cards)