Gazira Hospital of Renal Diseases

&SurgeryUrology Department

Unit of Mr: 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

SCREENING TESTS

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

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Liver, germ cell cancer of ovaries or testes

• Also elevated during pregnancy

• Help diagnose, monitor treatment, and determine recurrence

• Blood

B2M (Beta-2 microglobulin)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Multiple myelomaand lymphomas

• Crohn's disease and hepatitis

• Determine prognosis

• Blood

CA 15-3 (Cancer antigen 15-3)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Breast cancer and lung, ovarian

• Also elevated in benign breast conditions

• Stage disease, monitor treatment, and determine recurrence

• Blood

CA 19-9 (Cancer antigen 19-9)

• CANCERS

• WHAT ELSE?

WHEN/HOW USED

USUAL SAMPLE

• Pancreatic, sometimes colorectal and bileducts

• Pancreatitis and inflammatory bowel disease

• Stage disease, monitor treatment, and determine recurrence

• Blood

CA-125 (Cancer antigen 125)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Ovarian

• endometriosis, some other benign diseases

• Help diagnose, monitor treatment, and determine recurrence

• Blood

Calcitonin

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Thyroid medullary carcinoma

• pernicious anemia and thyroiditis

• Help diagnose, monitor treatment, and determine recurrence

• Blood

CEA (Carcino-embryonic antigen

• CANCERS

WHAT ELSE?

WHEN/HOW USED

• USUAL SAMPLE

• Colorectal, lung,breast, thyroid, pancreatic, liver, cervix, and bladder

• hepatitis, COPD, colitis, pancreatitis, and in cigarette smokers

• Monitor treatment and determine recurrence

• Blood

Chromogranin A (CgA)

• CANCERS

WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Neuroendocrine tumors (carcinoid tumors, neuroblastoma)

• May be most sensitive tumor marker for carcinoid tumors

• To help diagnose and monitor

• Blood

Estrogen receptors

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Breast

• Increased in hormone-dependent cancer

• Determine prognosis and guide treatment

• tissue

hCG (Human chorionic gonadotropin)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Testicular and trophoblastic disease

• Elevated in pregnancy, testicular failure

• Help diagnose, monitor treatment, and determine recurrence

• Blood, urine

Her-2/neu

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Breast• Oncogene that is

present in multiple copies in 20-30% of invasive breast cancer

• Determine prognosis and guide treatment

• Tissue

Monoclonal immunoglobulins

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED

• USUAL SAMPLE

• Multiple myeloma and Waldenstrom’s macroglobulinemia

• Overproduction of an immunoglobulin or antibody, usually detected by protein electrophoresis

• Help diagnose,monitor treatment, and determine recurrence

• Blood, urine

Progesterone receptors

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Breast

• Increased in hormone-dependent cancer

• Determine prognosis and guide treatment

• Tissue

PSA (Prostate specific antigen), total and free

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED

• USUAL SAMPLE

• Prostate

• benign prostatic hyperplasia, prostatitis and with age

• Screen for and help diagnose, monitor treatment, and determine recurrence

• Blood

Thyroglobulin

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Thyroid

• Used after thyroid is removed to evaluate treatment

• Determine recurrence

• Blood

Other Tumor Markers Less Widely Used

BTA (Bladder tumor antigen)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Bladder

• Not widely available, but gaining acceptance

• Help diagnose and determine recurrence

• Urine

CA 72-4 (Cancer antigen 72-4)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Ovarian

• No evidence that it is better than CA-125 but may be useful when combined with it; still being studied

• Help diagnose• Blood

Des-gamma-carboxy prothrombin

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED

• USUAL SAMPLE

• Hepatocellular carcinoma (HCC)

• New test; often used along with an imaging study plus AFP and/or AFP-L3% to evaluate if someone with

• To evaluate risk of developing HCC; to evaluate treatment; to

• Blood

NMP22

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Bladder

• Not widely used

• Help diagnose and determine recurrence

• Urine

Prostate-specific membrane antigen (PSMA)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Prostate

• Not widely used; levels increase normally with age

• Help diagnose• Blood

Prostatic acid phosphatase (PAP)

• CANCERS

• WHAT ELSE?

• WHEN/HOW USED • USUAL SAMPLE

• Metastatic prostate cancer, myeloma, lung cancer

• Not widely used anymore; elevated in prostatitis and other conditions

• Help diagnose

• Blood

THANKS