TUMOR MARKERS.-1.pptx by Aikoman radiology scientist at Catholic University of health and allied sciences Mwanza.

By Aikoman.

1. Characteristics of Ideal Tumor Marker 1. TM should be present in or produced by tumor itself. 2. TM should not be present in healthy tissues. 3. Plasma level of TM should be at a minimum level in healthy subjects and benign lesions . 4. TM should be specific for a tissue 5. Half life of a tumor marker should not be very long 6 . TM levels correlates with the tumour stage, tumour mass, and regression (during treatment or recurrence) 7 . TM should be present in plasma at a detectable level, even when tumor size is very small

2. CLASSIFICATION OF TUMOR MARKERS ACCORDING TO THE MOLECULE. Enzymes ( PSA, ALP ) Hormones ( hCG , inhibin ) Oncofetal ( AFP, CEA ) Glycoproteins / charbohydrates ( CA 125, CA 15-3) Proteins ( immunoglobulin, thyroglobulin )

3. I.ENZYMES AS TUMOR MARKERS. Prostate Specific Antigen(PSA) Produced only in the epithelial cells of the acini and ducts of the prostate gland Functionally regulates seminal fluid viscosity Detection of total PSA has been used in screening for and in monitoring of prostate cancer it’s a tumor marker for prostste cancer. ALKALINE PHOSPHATASE (ALP) ALP is mainly present in liver, biliary tract, bone and placenta. Increased ALP can be seen in liver cancer Cancer of biliary tract Metastatic cancer with bone or liver involvement Testicular seminomas .

4. II. HORMONES AS TUMOR MARKERS. HUMAN CHORIONIC GONADOTROPIN(HCG). hCG is secreted by trophoblasts in the placenta to maintain the corpus luteum during pregnancy. hCG is elevated in trophoblastic tumors choriocarcinoma germ cell tumors of the ovary and testis. hCG has several clinical applications as a tumor marker. it is a prognostic indicator for ovarian cancer a diagnostic marker for classification of testicular cancer the most useful marker for detection of gestational trophoblastic diseases (GTDS) Pregnancy test INHIBIN . Inhibin is a produced by granulosa cells of the ovary and sertoli cells of the testes. Certain sex cord- stromal tumors can produce inhibin . Inhibin is a peptide hormone produced by ovarian granulosa cells. This is the tumor marker for mucinous epithelial ovarian carcinomas .

5. III. ONCOFETAL ANTIGENS AS TUMOR MARKERS. A- FETOPROTEIN(AFP) Synthesized by the yolk SAC, the fetal liver and gut and is major plasma protein. In adults the normal conc is <10 g/L. Increased plasma conc of protein are seen in normal pregnancy. It’s a tumor markerfor liver cell cancer. Also used in diasgnosis of neural tube defects, hepatocellular carcinomas (HCC ) and tesotherticular teratomas and other germ cell carcinoma. CARCINOEMBRYONIC ANTIGEN(CEA) tumor marker for colorectal cancer, produced by normal fetal gut cells and colorectal cancer cells in adult. also frequently elevated in lung, breast , and gastrointestinal tumors but also high levels of CEA (>10 ng / mL ) are associated with non malignant conditions like liver disease, pancreatitis and inflamatory bowel disease . therefore CEA is not used for screening, since its not specific to colorectal cancer.

6. IV. Glycoproteins CANCER ANTIGEN 125(CA 125) its a glycoprotein Produced by epithelial cells lining female reproductive tract including ovarian tissue. it is also elevated in patients with endometriosis during the first trimester of pregnancy during menstruation. A high level (> 95 U/ mL ) of CA-125 has a 90% positive predictive value for ovarian cancer. A marker for ovarian cancer. CANCER ANTGEN 15-3 (CA 15-3) Is a glycoprotein Produced by certain breast cancer cells. Its shed in bloodstream hence detected in serum. A marker for breast carcinoma. It may also be present in pancreatic, Lung, Ovarian, Colorectal and liver cancer and in some breast benign

7. V. PROTEIN AS TUMOR MARKER. THYROGLOBULIN . Synthesized by thyroid cells and stored within thyroid gland as the precursor to T3 & T4. In thyroid cancer, both normal& cancerous thyroid cells produce thyroglobulin , hence elevated levels in blood. Is a useful marker for detection of differentiated thyroid cancer. IMMUNOGLOBULIN . Bence -Jones protein is produced by abnormal plasma cells in the bone marrow. Bence -Jones protein is a free monoclonal immunoglobulin light chain in the urine and its reliable marker for multiple myeloma.