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Gazira Hospital of Renal Diseases    &Surgery    Urology Department              Unit ofMr: Mostafa Omran,Prof:Mohamed    ...
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 o...
Definition• Most of the well-known markers may also be  elevated in non-cancerous conditions.  Consequently, tumor markers...
Definition• Some markers cause great excitement when  they are first discovered but, upon further  investigation, prove to...
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 ...
CEA• carcinoembryonic antigen, is a blood-borne  protein, first noted to be produced by tumors  of the gastrointestinal sy...
Tissue-specific markers• Related to specific tissues which have  developed cancer      - these substances are not specific...
AFPAFP is a major plasma protein( glycoprotein )  produced by the yolk sac and the liver during  fetal development that is...
AFP• - It used as a biomarker to detect a subset of  tumors in non-pregnant women, men, and  children.  A level above 500 ...
Gene Mutations• Some people are at a higher risk for particular  cancers because they have inherited a genetic  mutation.•...
USES• Tumor markers are not diagnostic in  themselves.• A definitive diagnosis of cancer is made by  looking at tissue bio...
USES• 1-Screen• PSA testing may be used to screen for prostate  cancer.• 2-Diagnose• CA-125 for ovarian cancer.• 3-Stage• ...
USES• 6-Monitor Treatment      AFP in a child previously treated for  teratoma suggests relapse with endodermal  sinus tum...
SCREENING TESTS
Prostate Specific Antigen (PSA)• the only tumor marker to gain wide  acceptance as a screening test is Prostate  Specific ...
Other markers• Other markers are either not specific enough  (too many false positives, leading to expensive  and unnecess...
Common Tumor Markers Currently          in Use
AFP (Alpha-feto protein)• CANCERS           • Liver, germ cell cancer                      of ovaries or testes• WHAT ELSE...
B2M (Beta-2 microglobulin)• CANCERS         • Multiple myeloma                    and lymphomas• WHAT ELSE?      • Crohns ...
CA 15-3 (Cancer antigen 15-3)• CANCERS         • Breast cancer and lung,                    ovarian• WHAT ELSE?      • Als...
CA 19-9 (Cancer antigen 19-9)• CANCERS         • Pancreatic, sometimes                    colorectal and bileducts• WHAT E...
CA-125 (Cancer antigen 125)• CANCERS         • Ovarian• WHAT ELSE?      • endometriosis, some                    other ben...
Calcitonin• CANCERS             • Thyroid medullary                        carcinoma• WHAT ELSE?          • pernicious ane...
CEA (Carcino-embryonic antigen• CANCERS        • Colorectal, lung,                   breast, thyroid,                   pa...
Chromogranin A (CgA)• CANCERS         • Neuroendocrine tumors                    (carcinoid tumors,                    neu...
Estrogen receptors• CANCERS            • Breast• WHAT ELSE?         • Increased in hormone-                       dependen...
hCG (Human chorionic gonadotropin)• CANCERS         • Testicular and                    trophoblastic disease• WHAT ELSE? ...
Her-2/neu• CANCERS             • Breast                      • Oncogene that is• WHAT ELSE?            present in multiple...
Monoclonal immunoglobulins• CANCERS         • Multiple myeloma and                    Waldenstrom’s                    mac...
Progesterone receptors• CANCERS         • Breast• WHAT ELSE?      • Increased in hormone-                    dependent can...
PSA (Prostate specific antigen), total               and free• CANCERS           • Prostate• WHAT ELSE?        • benign pr...
Thyroglobulin• CANCERS             • Thyroid• WHAT ELSE?          • Used after thyroid is                        removed t...
Other Tumor Markers Less Widely            Used
BTA (Bladder tumor antigen)• CANCERS         • Bladder• WHAT ELSE?      • Not widely available,                    but gai...
CA 72-4 (Cancer antigen 72-4)• CANCERS         • Ovarian• WHAT ELSE?      • No evidence that it is                    bett...
Des-gamma-carboxy prothrombin• CANCERS         • Hepatocellular carcinoma                    (HCC)• WHAT ELSE?      • New ...
NMP22• CANCERS           • Bladder• WHAT ELSE?        • Not widely used• WHEN/HOW USED     • Help diagnose and            ...
Prostate-specific membrane antigen               (PSMA)• CANCERS         • Prostate• WHAT ELSE?      • Not widely used; le...
Prostatic acid phosphatase (PAP)• CANCERS         • Metastatic prostate                    cancer, myeloma, lung          ...
THANKS
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Tumor markers

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Tumor markers

  1. 1. Gazira Hospital of Renal Diseases &Surgery Urology Department Unit ofMr: Mostafa Omran,Prof:Mohamed Elemam& Mr: Sami
  2. 2. Tumor Markers Presented by: Dr: Adam Mohammed Ibrahim
  3. 3. 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.
  4. 4. 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.
  5. 5. 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.
  6. 6. Classification• Tumor markers can be classified in two groups: 1-Cancer-specific markers 2-tissue-specific markers.
  7. 7. 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
  8. 8. 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.
  9. 9. 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.
  10. 10. 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.
  11. 11. 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. -
  12. 12. 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.
  13. 13. 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:
  14. 14. 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).
  15. 15. USES• 6-Monitor Treatment AFP in a child previously treated for teratoma suggests relapse with endodermal sinus tumor.• 7-Determine Recurrence
  16. 16. SCREENING TESTS
  17. 17. 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.
  18. 18. 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
  19. 19. Common Tumor Markers Currently in Use
  20. 20. 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
  21. 21. B2M (Beta-2 microglobulin)• CANCERS • Multiple myeloma and lymphomas• WHAT ELSE? • Crohns disease and hepatitis• WHEN/HOW USED • Determine prognosis• USUAL SAMPLE • Blood
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. Calcitonin• CANCERS • Thyroid medullary carcinoma• WHAT ELSE? • pernicious anemia and thyroiditis• WHEN/HOW USED • Help diagnose, monitor treatment, and determine recurrence• USUAL SAMPLE • Blood
  26. 26. 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
  27. 27. 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
  28. 28. Estrogen receptors• CANCERS • Breast• WHAT ELSE? • Increased in hormone- dependent cancer• WHEN/HOW USED • Determine prognosis and guide treatment• USUAL SAMPLE • tissue
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. Progesterone receptors• CANCERS • Breast• WHAT ELSE? • Increased in hormone- dependent cancer• WHEN/HOW USED • Determine prognosis and guide treatment• USUAL SAMPLE • Tissue
  33. 33. 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
  34. 34. Thyroglobulin• CANCERS • Thyroid• WHAT ELSE? • Used after thyroid is removed to evaluate• WHEN/HOW USED treatment • Determine recurrence• USUAL SAMPLE • Blood
  35. 35. Other Tumor Markers Less Widely Used
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. NMP22• CANCERS • Bladder• WHAT ELSE? • Not widely used• WHEN/HOW USED • Help diagnose and determine recurrence• USUAL SAMPLE • Urine
  40. 40. 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
  41. 41. 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
  42. 42. THANKS

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