tumor marker . esp. thanks to worthy HOD Syed Talha ahmed Consultant ChemPath

1. TUMOR
MARKER

2. TYPES OF TUMOR MARKERS
 • Hormones (hCG; calcitonin; gastrin; prolactin;)
 • Enzymes (acid phosphatase; alkaline phosphatase; PSA)
 • Cancer antigen proteins & glycoproteins (CA125; CA 15.3; CA19.9) •
 Metabolites (norepinephrine, epinephrine)
 • Normal proteins (thyroglobulin) • Oncofetal antigens (CEA, AFP) •
Receptors (ER, PR )

3. CHARACTERISTICS OF AN IDEAL TUMOR MARKER
 Specificity for a single type of cancer
 High sensitivity and specificity for cancerous growth
 Correlation of marker level with tumor size
 Homogeneous (i.e., minimal post-translational modifications)
 • Short half-life in circulation

4. ROLES FOR TUMOR MARKERS
 Determine risk (PSA)
 Screen for early cancer (calcitonin, occult blood)
 Diagnose a type of cancer (hCG, catecholamines)
 Estimate prognosis (CA125)
 Predict response to therapy (CA15-3, CA125, PSA, hCG)
 Monitor for disease recurrence or progression (most widely used function)
 Therapeutic selection (her2/neu, kras)

5. PROSTATE CANCER
Most commonly
diagnosed in
men aged 65-74
years old .
2015 USA Tietz
Account for 13.3
% of all new
cancers – among
4.7 % of all
cancer death
Common
symptoms
frequency
,urgency ,acute
retention ,back
pain ,weight loss
,anemia
Over all survival
rate is 5 years .
.
Prostectomy
,
Brachytherapy
Radiotherapy

6. PROSTATE-SPECIFIC ANTIGEN (PSA)
 PSA, or human kallikrein 3 (hK3) is a 33-kDa serine-protease of the tissue
kallikrein family that was identified in prostatic extracts in the 1970s
 PSA was discovered in human sera by Wang et al (11) and later isolated from
prostate tissue by Papsidero et al

7. PROSTATE-SPECIFIC ANTIGEN (PSA)
 Prostate-specific antigen (PSA) is a single-chain glycoprotein normally found
in the cytoplasm of the epithelial cells lining the acini and ducts of the prostate
gland. PSA is a neutral serine protease of 240 amino acids involved in the
lysis of seminal coagulum
 PSA is a organic specific but not cancer specific because its concentration
increased in Benign prostate hypertrophy ,UTI, & Surgical intervention
 Biopsy is required for definitive diagnosis

8. PROSTATIC SPECIFIC ANTIGEN (PSA):

9. FREE PSA (FPSA)

10. AGE RELATED REFERENCE INTERVALS
 Historically, a single PSA value less than 4.0 ug/dl has been used . Higher value in older men (
less 5.0 / 6.0 )
could decrease unnecessary biopsies (increase specificity)
 Lower reference interval in younger group less than 2.5 -3.0 could increase cancer detection (
improve sensitivity)
 Race specific reference have been suggested because some population (African American) PSA
tend to be higher .
 The NHA Prostate Cancer Screening Management Program recommended Age related reference
intervals

11.  Measurement of serum PSA levels is not recommended as a screening
procedure for the diagnosis of cancer because elevated PSA levels also are
observed in patients with benign prostatic hypertrophy. However, studies
suggest that the measurement of PSA in conjunction with digital rectal exam
(DRE) and ultrasound provide a better method of detecting prostate cancer
than DRE alone.
 serial PSA levels can help determine the success of prostatectomy and the
need for further treatment, such as radiation, endocrine or chemotherapy, and
can help in monitoring the effectiveness of therapy.

12. Serum samples with total PSA levels > 100.00 ng/mL (µg/L) must be
diluted and retested to obtain accurate result

13. PANCREATIC CANCER
USA
12th most common
cancer
.representing 3% of
all new cases
2015 USA Tietz
More common men
,
Median age at
diagnosis is 71 ,
Symptoms :
jaundice ,
pain ,nausea
,vomiting & pruritus
Over all survival rate
is 5 years .
Pancreatectomy
.

14. PANCREATIC CANCER
 Carbohydrate antigen 19-9 (CA 19-9) is a cell surface glycoprotein complex most commonly
associated with pancreatic ductal adenocarcinoma (PDAC).
 Koprowski first described it in 1979 using a mouse monoclonal antibody in a colorectal
carcinoma cell line. Historically, it is one of the most commonly used tumor markers for
diagnosing, managing, and prognosticating PDAC
 Carbohydrate antigen 19-9 (CA 19-9), also known as Sialyl Lewis-a, is a cell surface
glycoprotein complex.

15. PANCREATIC CANCER
 In asymptomatic and symptomatic populations, it is well-established that CA 19-9 is an
ineffective screening tool due to low positive predictive value (PPV) .
 It contributes to diagnosis with sensitivity of 79% to 81 % & specificity of 82 to 90 %
 Ca-19-9 may be increased in biliary infection ,(cholangitis ), inflammation ,biliary obstruction
,so its measured after biliary decompensation & bilirubin is normal .
 It should only be measured in patients in whom pancreatic cancer is suspected

16.  For diagnostic purposes, these guidelines recommend CA 19-9 as an adjunct
to radiological investigations such as the pancreas protocol computed
tomography (CT), which is the current gold standard[1e National Academy of
Clinical Biochemistry (United States)

17.  Interference of heterophilic antibodies causing false positive CA-19-9 results
has been documented, and usually treating the specimen with heterophilic
antibody-blocking agents can eliminate such interference. Patients with acute
or chronic pancreatitis may also have elevated levels of CA-19-9. In
addition, pulmonary diseases may also elevate CA-19-9 levels. Liver
cirrhosis, Crohn’s disease, and benign gastrointestinal diseases can also
increase CA-19-9 levels.

19. Thank you

20. REFERENCES
