Endocrinological Markers in Gynaecological Tumours - an overview.
Tumour markers are biochemical indicators selectively produced by the neoplastic tissue or by other cells in the body in response to neoplasm and released into the blood and detectable in blood or other tissue fluids.
Various molecules that can act as Tumour Markers:
Enzymes and Isoenzymes (ALP, LDH)
Hormones (Beta-HCG, HPL, Inhibin, AMH)
Oncofoetal Proteins (CEA, AFP)
Carbohydrate epitopes( CA125, CA 15-3, CA 19-9)
Receptors( oestrogen, progesterone and testosterone)
Serum and tissue protein( TAG 72, HE 4)
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Tumor markers are substances, such as proteins, biochemicals, hormones or enzymes, produced by tumor cells or by the body in response to tumor cells. As tumor cells multiply, cancer spreads, and tissue is damaged, these substances increase and leak into the bloodstream. Tumor marker levels in blood help physicians evaluate people for certain types of cancer
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Tumor markers are substances, such as proteins, biochemicals, hormones or enzymes, produced by tumor cells or by the body in response to tumor cells. As tumor cells multiply, cancer spreads, and tissue is damaged, these substances increase and leak into the bloodstream. Tumor marker levels in blood help physicians evaluate people for certain types of cancer
Tumour Markers are substances present in the tumour, produced by the tumour or by the host as a response to the presence of the tumour, providing information about biological characteristics of the tumour. these tumour markers may specific for the tissue but often get elevated in neoplastic as well non-neoplastic lesions, further Various analytical platforms available for serum tumour markers lack standardisation. These factors add to interpretative challenges in serum tumour markers
Tumor markers
Many cancers are associated with the abnormal production of some molecules which can be measured in plasma. These molecules are known as tumor markers.
A good tumor maker should have those properties:
1. A tumor marker should be present in or produced by tumor itself.
2. A tumor marker should not be present in healthy tissues.
3. Plasma level of a tumor marker should be at a minimum level in healthy subjects and in benign conditions.
4. A tumor marker should be specific for a tissue, it should have different immunological properties when it is synthesized in other tissues.
5. Plasma level of the tumor marker should be in proportion to the both size of the tumor and the activity of the tumor.
6. Half-life of a tumor should not be very long
7. A tumor marker should be present in plasma at a detectable level, even though tumor size is very small
Tumor Markers include a wide range of biomacromolecules orchestrated in abundance fixation by a wide assortment of neoplastic cells. The markers could be endogenous results of exceptionally dynamic metabolic threatening cells or the results of recently turned on qualities, which stayed unexpressed in early life or recently obtained antigens at cell and sub-cell levels. The presence of tumor marker and their focus are identified with the beginning and development of dangerous tumors in patients. A perfect tumor marker ought to be profoundly delicate, explicit, dependable with high prognostic worth, organ particularity and it should relate with tumor stages. Be that as it may, none of the tumor markers answered to date has every one of these attributes. Inspite of these impediments, numerous tumor markers have indicated incredible clinical significance in checking adequacy of various methods of treatments during whole course of sickness in malignant growth patients. Moreover, assurance of markers additionally helps in early discovery of malignant growth repeat and in anticipation.
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
RRRR IN OBSTETRIC HEMORRHAGE 09012024 AICOG 2024 HEYDERABAD.pptxNiranjan Chavan
This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth
Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptxNiranjan Chavan
Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
2. Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
Joint Treasurer, FOGSI (2021-2024)
President, MOGS (2022-2023)
Member Oncology Committee, SAFOG (2021-2023)
Joint Secretary, AFG(2022-2023)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS, JGOG & TOA Journal
60 publications in International and National Journals with 109 Citations
National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2022)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH
(2018-19)
DR. NIRANJAN CHAVAN
MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP,
DIPLOMA IN ENDOSCOPY (USA)
3. • The history of currently used tumour markers began in the 1940s, the first
discovered being alpha-fetoprotein in 1956, followed by that of
carcinoembryonic antigen in 1965.
• Since then the range of tumor markers has widened continuously.
• Their chemical structure and genetics are now well known.
4. TUMOUR MARKERS
Tumour markers are biochemical indicators selectively
produced by the neoplastic tissue or by other cells in the
body in response to neoplasm and released into the
blood and detectable in blood or other tissue fluids.
5. CLINICAL APPLICATION
Tumour markers can be used to
• Confirm presence of tumour
• Monitor progress of a disease
• Monitor response to treatment
• Can not be used as primary
modality for diagnosis of tumour
• No marker is completely specific;
therefore, diagnostic
immunohistochemistry testing
must be used in conjunction with
morphologic and clinical findings.
6. CHARACTERISTICS OF AN IDEAL
TUMOUR MARKER
• It should have high sensitivity and specificity for cancer cells.
• Correlate marker level with size or extent of actual tumour.
• Measurement in blood or urine should be able to detect subclinical disease.
• Inexpensive and acceptable.
7. VARIOUS MOLECULES THAT CAN
ACT AS TUMOUR MARKERS
• Enzymes and Isoenzymes (ALP
, LDH)
• Hormones (Beta-HCG, HPL, Inhibin, AMH)
• Oncofoetal Proteins (CEA, AFP)
• Carbohydrate epitopes( CA125, CA 15-3, CA 19-9)
• Receptors( oestrogen, progesterone and testosterone)
• Serum and tissue protein( TAG 72, HE 4)
10. BETA HUMAN CHORIONIC
GONADOTROPIN (BETA HCG)
• Both beta-hCG and human
placental lactogen (hPL) are
the most useful markers for
trophoblastic disease and
can be localized in
syncytiotrophoblasts of
partial and complete
hydatidiform moles
11. • Increased levels of beta-HCG occur in patients with
1. Choriocarcinoma of the uterus
2. Embryonal carcinomas
3. Polyembryomas
4. Mixed cell tumours
5. Dysgerminomas
12. HCG
• Selectively produced by the syncytiotrophoblast
• Normal titre 20 to 30 mIU/ml
• Glycoprotein having molecular weight 36,000 to 40,000
• Half life 32 to 37 hours
• Has two fractions alpha and beta.
• There is an immunological and biological similarity
between alpha fraction and pituitary gonadotropins.
• Beta fraction of HCG is specific which is measured by
immunological & biological methods, RIA and enzyme
immunoassay.
13. BETA- HCG
• Can be detected in pregnancy one day after
implantation, 8 days after ovulation and 9 days
after surge.
• Concentration rises exponentially until 9 to
10weeks of gestation with a doubling time of 1.3 to
2days.
• It decreases from this peak level to a plateau value
of 10,000 to 20,000 IU/ml, which is maintained for
the remainder of the pregnancy.
• BHCG level reaches its normal, non-pregnant levels
of less than 5mU/ml, 21 to 24 days after delivery.
14. BETA HCG AS A TUMOUR MARKER
• Hydatidiform mole is very much suggestive if: - urine
in dilution of 1 in 200 to 1 in 500 is positive for HCG
beyond 100 days of gestation.
• -If Beta HCG in urine in 24 hours is around 0.3 to 3
million IU during a similar period of amenorrhoea.
• Molar pregnancy patients are more prone to develop
Choriocarcinoma:-If excreting Beta HCG > 100,000
IU/ in urine in 24hours -If serum level of HCG is >
40,000 mIU/ml.
15. Choriocarcinoma
• A single tumour cell produces beta-
HCG around 5x10-5 to 5x10-4 IU/24
hours.
• Normally a woman excretes beta-
HCG of less than 4 IU in 24 hours.
• During methotrexate, treatment – The
serum level of beta-HCG is measured
at weekly intervals and
• The beta-HCG regression curve
serves as an indicator to determine
the need for a second course of
chemotherapy.
16. Patients who have undergone molar pregnancy evacuation
should undergo weekly beta-hCG monitoring until normal
levels are achieved, then monthly monitoring until 6-12
months of normal values have been achieved.
A 10% rise in beta-hCG over 3 or more weekly titres or a
beta hCG titre of 40,000 mIU/L 4-5 months after uterine
evacuation constitutes a serological diagnosis of post
molar trophoblastic disease.
17. • Following a molar pregnancy, which is mostly
a benign disease, GTN is diagnosed as follows
according to the FIGO consensus statement
of 2000
• When the plateau ß-hCG lasts for 4
measurements over a period of 3 weeks or
longer, that is day 1, 7, 14, 21.
• When there is a rise of ß-hCG of three weekly
consecutive measurements or longer, over at
least a period of 2 weeks or more days 1, 7,
14.
• When the ß-hCG level remains elevated for 6
months or more.
• GTN is diagnosed if there is a histological
diagnosis of choriocarcinoma.
Modified WHO prognostic scoring system as
adopted by FIGO(2000)
18. HUMAN PLACENTAL LACTOGEN
• Human placental lactogen(HPL) is localized in syncytiotrophoblasts
• hPL is present only during pregnancy, with maternal serum levels rising in
relation to the growth of the fetus and placenta.
• Maximum levels are reached near term, typically to 5–7 mg/L.
• Higher levels are noted in patients with multiple gestation.
• Its biological half-life is 15 minutes.
• Markedly elevated in Placental Site Trophoblastic Tumour. (PsTT)
19. • In 1983, the World Health Organization (WHO) formally acknowledged and adopted
the terminology of PSTT.
• PSTT can occur following term labor, abortion and rarely in molar pregnancy.
• Blood β-hCG was usually normal or only slightly increased, and the levels are not
proportional to the tumour burden. This differs from many of the GTDs, which often
have a high β-hCG level. However, other types of GTDs with a low serum β-hCG
level have also been reported
• Ultrasound findings often lack of specificity. A definitive diagnosis requires histology
examination in conjunction with IHC studies.
• The IHC studies show tumor cells positive for human placental lactogen (hPL)
placental alkaline phosphatase (PLAP) and smooth muscle actin (SMA).
20. INHIBIN
• Inhibins are heterodimeric protein
hormones secreted by granulosa
cells of the ovary in the female and
Sertoli cells of the testis in the male.
• Inhibin is complementary to cancer
antigen 125 (CA 125) as an ovarian
cancer marker.
• Inhibin shows a better performance
in mucinous and granulosa ovarian
cell tumours.
21. • They selectively suppress the
secretion of pituitary follicle
stimulating hormone (FSH) and
have local paracrine actions in the
gonads. [1]
• The inhibin consists of a dimer of 2
homologous subunits, an alpha
subunit and either a beta A or beta
B subunit, to form inhibin A and
inhibin B respectively.
Granulosa cell tumour histopathology
and immunostaining
22. • Elevations of serum inhibin A and B are detected in
some patients with granulosa cell tumours.
• Inhibin A elevations have been reported in
approximately 70% of granulosa cell tumours.
• inhibin is not a very good marker in non-
mucinous epithelial tumours..
• Total inhibin is elevated in 15% to 35% of
nonmucinous epithelial ovarian cancer cases.
• Elevation of 6-fold to 7-fold over the reference
range value.
• 20% of epithelial tumours of the mucinous type
with about cases have elevated inhibin A levels.
23. • According to this study, the most widely used marker for ovarian cancer, serum CA-
125, was less helpful in identifying mucinous borderline cystic tumours.[3]
• Among the women with mucinous borderline cystic tumours, (11 percent) tested had
an elevated serum CA 125 concentration, whereas (77 percent) with this tumour who
were tested had elevated serum inhibin concentrations.
• The finding of elevated serum inhibin concentrations in women with mucinous
borderline cystic tumours suggests that the capacity to secrete inhibin is increased
early in the process of malignant transformation.
• The high frequency of elevated values in women with mucinous carcinomas (82
percent) is particularly important because there is no hormonal marker for this type of
cancer.
24. ANTI-MULLERIAN HORMONE (AMH)
• The Anti-Mullerian hormone
(AMH), which is produced by fetal
Sertoli cells, is responsible for
regression of Mullerian ducts
during male sex differentiation.
• Ovarian granulosa cells also
secrete AMH from late in fetal life.
25. • The patterns of expression of AMH and its type II receptor in the post-natal ovary indicate
that AMH may play an important role in ovarian folliculogenesis.
• AMH can be used as a diagnostic marker and therapeutic agent for ovarian cancer,
specifically for granulosa cell tumours (GCT). Its diagnostic performance seems very good,
with a sensitivity between 76 and 93%.
AMH immunostaining of granulosa
cell tumours (GCT).
26. • It is largely recognized that AMH
and alpha-inhibin exhibit a higher
degree of sensitivity than estradiol
in progressive GCT.
• However, AMH is elevated only in
sex cord stromal tumours, while
inhibin may be elevated in different
types of cancer
27. • It is known that there is no clinically significant fluctuation of serum AMH levels during the menstrual
cycle in healthy premenopausal women.
• Serum AMH measurement can be reliably used in the follow-up of AGCT patients at any time of the
cycle.
• Serum AMH and inhibin B measurements perform equally in detecting AGCTs, and combining them
improves the detection of AGCT recurrence compared with inhibin B measurement alone.
• The development of novel improved detection methods and a better understanding of AMH as a
molecule will shed more light on the biological role and clinical applications of AMH in AGCTs[4]
28. REFERENCES
• 1. https://oncology.testcatalog.org/
• 2. La Marca A, Volpe A. The Anti-Mullerian hormone and ovarian cancer. Hum Reprod Update [Internet].
2007;13(3):265–73. Available from: http://dx.doi.org/10.1093/humupd/dml060
• 3. Phocas I, Sarandakou A, Sikiotis K, Rizos D, Kalambokis D, Zourlas PA. A comparative study of serum alpha-beta A
immunoreactive inhibin and tumor-associated antigens CA125 and CEA in ovarian cancer. Anticancer Res. 1996
Nov-Dec;16(6B):3827-31. PMID: 9042265.
• 4. Färkkilä A, Koskela S, Bryk S, Alfthan H, Bützow R, Leminen A, Puistola U, Tapanainen JS, Heikinheimo M, Anttonen
M, Unkila-Kallio L. The clinical utility of serum anti-Müllerian hormone in the follow-up of ovarian adult-type
granulosa cell tumors--A comparative study with inhibin B. Int J Cancer. 2015 Oct 1;137(7):1661-71. doi:
10.1002/ijc.29532. Epub 2015 Apr 11. PMID: 25808251.
29. FUTURE OF TUMOUR MARKERS
• It is proving extremely difficult to find new cancer biomarkers with adequate
sensitivity and specificity to be used in the clinic.
• Even within the same tumour, molecular heterogeneity is enormous and
differences can be seen in primary vs. metastatic sites or as tumours evolve over
time.
• These new findings support the view that it is highly unlikely to identify a single
marker which will be elevated in nearly all patients with a specific malignancy.
30. • There are currently hundreds, if not thousands, of
rare tumor markers which perform at high
specificity (> 90%), but at relatively low sensitivity (<
30%).
• Borrowing from the principles of precision
medicine, these low sensitivity markers, may be
useful to specific patients.
• We can apply screening new patients for hundreds
of cancer biomarkers to identify a few that are
informative, and then use them clinically.
31. • This is similar to what is currently done with
genomics to identify personalized therapies.
• This approach may explain why some
biomarkers are elevated in only a small
group of patients.
• It is likely that these differences in
expression are linked to specific genomic
alterations, which could then be found with
genomic sequencing.