Tumour Markers & Myelosuppression

Question 1

What are the 2 qualities a tumour marker should be?

Answer 1

Highly specific

Highly sensitive

Question 2

Define sensitivity

Answer 2

The sensitivity of a marker describes its ability to detect those with a certain disease

Question 3

Define specificity

Answer 3

The specificity of a marker describes its ability to accurately define those who are disease free.

Question 4

Name the cell surface glycoproteins

Answer 4

CA125- ovarian carcinoma, pregnancy, endometriosis, periods, pancreatic, lung, colorectal
CA19.9- Pancreatic
CEA- COLORECTAL, pancreatic, gastric, breast, lung, smoking, IBD

Question 5

Name the oncofetal proteins

Answer 5

HCG- hydatiform mole, choriocarcinoma, seminoma, pregnancy
αFP- hepatocellular carcinoma (in females), germ cell tumour (ovary/testis)
Germ Cell tumours (Teratoma): Raised αFP AND HCG

Question 6

Name the tumour marker enzymes

Answer 6

Acid phosphatase
Alkaline phosphatase
Lactate dehydrogenase
Neuronespecific enolase

Question 7

Name the tumour marker hormones

Answer 7

Thyroglobulin
ADH
Adrenocorticotrophic hormone

Question 8

Name the tumour marker immunoglobulins

Answer 8

Light chains

Bence Jones protein- myeloma

Question 9

What test should be done on a young male with widespread mets?

Answer 9

αFP, LDH, βHCG (pregnancy test)

Diagnoses chemo sensitive germ cell tumours

Question 10

Where is αFP normally secreted?

Answer 10

Normal foetal yolk sac
Liver
Intestines
Undetectable after first year of life

Question 11

What components of the blood drop with conventional chemo?

Answer 11

Pancytopenia:
Leukocytes
RBC
Neutrophils
Platelet count

Question 12

What does bone marrow replacement cause?

Answer 12

Pancytopenia

More common in haematological malignancies

Question 13

What haematological problems can para-neoplastic syndromes cause?

Answer 13

Pancytopenia

Single haematopoietic lineages to be affected

Question 14

How is anaemia caused in cancer?

Answer 14

• Iron deficiency: Blood loss from tumour

- Macrocytic Not megaloblastic: Chemo

Question 15

What investigations need to be done in myelosuppression?

Answer 15

Blood film
Measure heamatinics
Bone marrow aspirate
Trephine

Question 16

How is anaemia treated?

Answer 16

• Hb<10= blood transfusion

- Preventing symptoms & reducing risk of transfusion reactions & viral transmission= recombinant erythropoetin

Question 17

What are the clinical signs of thrombocytopenia?

Answer 17

Petechial haemorrhage
Spont. nosebleeds
Corneal haemorrhage
Haematuria

Question 18

When is a platelet count significant?

Answer 18

< 10 x 10(9) associated with signify risk of spont bleeding (intracerebral haemorrhage)

Question 19

When is a platelet transfusion required?

Answer 19

levels between 10-20 particularly in the presence of other complications (infection)

Question 20

What is neutropenic sepsis?

Answer 20

Total white count

<1 x 10(9) with associated fever

Question 21

How is neutropenic sepsis treated?

Answer 21

Immediate in-patient management with broad spec abx

Question 22

What physical exams should not be done on a neutropenic sepsis patient?

Answer 22

Vaginal
Rectal
Risk of causing bacteraemia if mucosa is breached

Question 23

What investigations need to be done on a neutropenic sepsis patient?

Answer 23

CXR
Bloods
Urine dip
Sputum sample
Throat swab