Gazira Hospital of Renal Diseases &Surgery Urology Department Unit ofMr: Mostafa Omran,Prof:Mohamed Elemam& Mr: Sami
Tumor Markers Presented by: Dr: Adam Mohammed Ibrahim
Definition• Tumor markers are substances, usually proteins, that are produced by the body in response to cancer growth or by the cancer tissue itself and that may be detected in blood, urine, or tissue samples.• Some tumor markers are specific for a particular type of cancer, while others are seen in several cancer types.
Definition• Most of the well-known markers may also be elevated in non-cancerous conditions. Consequently, tumor markers alone are not diagnostic for cancer.• There are well-established tumor markers that are routinely used . Many other potential markers are still being researched.
Definition• Some markers cause great excitement when they are first discovered but, upon further investigation, prove to be no more useful than markers already in use.
Classification• Tumor markers can be classified in two groups: 1-Cancer-specific markers 2-tissue-specific markers.
Cancer-specific markers- Related to the presence of certain cancerous tissue - these markers might not be specific in making a diagnosis - useful in the follow-up of treated patients -to describe progress of the disease -response to treatment. Examples of these markers are CEA, CA19-9, CA125
CEA• carcinoembryonic antigen, is a blood-borne protein, first noted to be produced by tumors of the gastrointestinal system. - it was produced by the lung and breast cancer case,an elevated level does not necessarily mean a bowel cancer. - a rising CEA level can be an early sign of recurring bowel cancer.
Tissue-specific markers• Related to specific tissues which have developed cancer - these substances are not specifically related to the tumor, and may be present at elevated levels when no cancer is present. - But unlike the previous group, elevated levels point to a specific tissue being at fault. - Examples include PSA, beta-HCG, ), AFP- L3, and Thyroglobulin.
AFPAFP is a major plasma protein( glycoprotein ) produced by the yolk sac and the liver during fetal development that is thought to be the fetal form of serum albumin. - AFP is measured in pregnant women through the analysis of maternal blood or amniotic fluid, as a screening test for a subset of developmental abnormalities -Increased in open neural tube defects and omphalocoele . -Decreased in Down syndrome.
AFP• - It used as a biomarker to detect a subset of tumors in non-pregnant women, men, and children. A level above 500 nanograms/milliliter of AFP in adults can be indicative of : -Hepatocellular carcinoma -Germ cell tumors -Metastatic cancers of the liver. -
Gene Mutations• Some people are at a higher risk for particular cancers because they have inherited a genetic mutation.• While not considered tumor makers, there are tests that look for these mutations in order to estimate the risk of developing a particular type of cancer.• BRCA1 and BRCA2 are examples of gene mutations.• related to an inherited risk of breast cancer and ovarian cancer.
USES• Tumor markers are not diagnostic in themselves.• A definitive diagnosis of cancer is made by looking at tissue biopsy specimens under a microscope.• . However, tumor markers provide information that can be used to:
USES• 1-Screen• PSA testing may be used to screen for prostate cancer.• 2-Diagnose• CA-125 for ovarian cancer.• 3-Stage• 4-Determine Prognosis• 5-Guide Treatment• Breast cancer patients who are Her2/neu positive are more likely to respond to Herceptin treatment).
USES• 6-Monitor Treatment AFP in a child previously treated for teratoma suggests relapse with endodermal sinus tumor.• 7-Determine Recurrence
Prostate Specific Antigen (PSA)• the only tumor marker to gain wide acceptance as a screening test is Prostate Specific Antigen (PSA) for prostate cancer in men.• Even with PSA there is continued debate among experts and national organizations over the usefulness of this test for screening asymptomatic men.
Other markers• Other markers are either not specific enough (too many false positives, leading to expensive and unnecessary follow-up testing) or they are not elevated early enough in the disease process to be useful for screening
Common Tumor Markers Currently in Use
AFP (Alpha-feto protein)• CANCERS • Liver, germ cell cancer of ovaries or testes• WHAT ELSE? • Also elevated during pregnancy• WHEN/HOW USED • Help diagnose, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood
B2M (Beta-2 microglobulin)• CANCERS • Multiple myeloma and lymphomas• WHAT ELSE? • Crohns disease and hepatitis• WHEN/HOW USED • Determine prognosis• USUAL SAMPLE • Blood
CA 15-3 (Cancer antigen 15-3)• CANCERS • Breast cancer and lung, ovarian• WHAT ELSE? • Also elevated in benign breast conditions• WHEN/HOW USED • Stage disease, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood
CA 19-9 (Cancer antigen 19-9)• CANCERS • Pancreatic, sometimes colorectal and bileducts• WHAT ELSE? • Pancreatitis and inflammatory bowel disease WHEN/HOW USED • Stage disease, monitor treatment, and determine recurrence USUAL SAMPLE • Blood
CA-125 (Cancer antigen 125)• CANCERS • Ovarian• WHAT ELSE? • endometriosis, some other benign diseases• WHEN/HOW USED • Help diagnose, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood
Calcitonin• CANCERS • Thyroid medullary carcinoma• WHAT ELSE? • pernicious anemia and thyroiditis• WHEN/HOW USED • Help diagnose, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood
CEA (Carcino-embryonic antigen• CANCERS • Colorectal, lung, breast, thyroid, pancreatic, liver, cervix, WHAT ELSE? and bladder • hepatitis, COPD, colitis, pancreatitis, and in cigarette smokers WHEN/HOW USED • Monitor treatment and determine recurrence• USUAL SAMPLE • Blood
Chromogranin A (CgA)• CANCERS • Neuroendocrine tumors (carcinoid tumors, neuroblastoma) WHAT ELSE? • May be most sensitive tumor marker for carcinoid tumors• WHEN/HOW USED • To help diagnose and monitor• USUAL SAMPLE • Blood
Estrogen receptors• CANCERS • Breast• WHAT ELSE? • Increased in hormone- dependent cancer• WHEN/HOW USED • Determine prognosis and guide treatment• USUAL SAMPLE • tissue
hCG (Human chorionic gonadotropin)• CANCERS • Testicular and trophoblastic disease• WHAT ELSE? • Elevated in pregnancy, testicular failure• WHEN/HOW USED • Help diagnose, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood, urine
Her-2/neu• CANCERS • Breast • Oncogene that is• WHAT ELSE? present in multiple copies in 20-30% of invasive breast cancer• WHEN/HOW USED • Determine prognosis and guide treatment• USUAL SAMPLE • Tissue
Monoclonal immunoglobulins• CANCERS • Multiple myeloma and Waldenstrom’s macroglobulinemia• WHAT ELSE? • Overproduction of an immunoglobulin or antibody, usually detected by protein electrophoresis • Help diagnose,• WHEN/HOW USED monitor treatment, and determine recurrence• USUAL SAMPLE • Blood, urine
Progesterone receptors• CANCERS • Breast• WHAT ELSE? • Increased in hormone- dependent cancer• WHEN/HOW USED • Determine prognosis and guide treatment• USUAL SAMPLE • Tissue
PSA (Prostate specific antigen), total and free• CANCERS • Prostate• WHAT ELSE? • benign prostatic hyperplasia, prostatitis• WHEN/HOW USED and with age • Screen for and help diagnose, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood
Thyroglobulin• CANCERS • Thyroid• WHAT ELSE? • Used after thyroid is removed to evaluate• WHEN/HOW USED treatment • Determine recurrence• USUAL SAMPLE • Blood
Other Tumor Markers Less Widely Used
BTA (Bladder tumor antigen)• CANCERS • Bladder• WHAT ELSE? • Not widely available, but gaining acceptance• WHEN/HOW USED • Help diagnose and determine recurrence• USUAL SAMPLE • Urine
CA 72-4 (Cancer antigen 72-4)• CANCERS • Ovarian• WHAT ELSE? • No evidence that it is better than CA-125 but may be useful when combined with it; still being studied• WHEN/HOW USED • Help diagnose • Blood• USUAL SAMPLE
Des-gamma-carboxy prothrombin• CANCERS • Hepatocellular carcinoma (HCC)• WHAT ELSE? • New test; often used along with an imaging study plus AFP and/or AFP-L3% to evaluate if someone with• WHEN/HOW USED • To evaluate risk of developing HCC; to evaluate treatment; to• USUAL SAMPLE • Blood
NMP22• CANCERS • Bladder• WHAT ELSE? • Not widely used• WHEN/HOW USED • Help diagnose and determine recurrence• USUAL SAMPLE • Urine
Prostate-specific membrane antigen (PSMA)• CANCERS • Prostate• WHAT ELSE? • Not widely used; levels increase normally with• WHEN/HOW USED age • Help diagnose• USUAL SAMPLE • Blood
Prostatic acid phosphatase (PAP)• CANCERS • Metastatic prostate cancer, myeloma, lung cancer• WHAT ELSE? • Not widely used anymore; elevated in prostatitis and other conditions• WHEN/HOW USED • Help diagnose• USUAL SAMPLE • Blood