Podcast
Questions and Answers
Which tumor marker is primarily used for monitoring ovarian cancer?
Which tumor marker is primarily used for monitoring ovarian cancer?
What is the primary clinical application of alpha-fetoprotein (AFP)?
What is the primary clinical application of alpha-fetoprotein (AFP)?
Which of the following is NOT classified under oncofetal proteins?
Which of the following is NOT classified under oncofetal proteins?
Which tumor marker would you use to distinguish prostate cancer from benign prostate hyperplasia?
Which tumor marker would you use to distinguish prostate cancer from benign prostate hyperplasia?
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In which type of cancer would you most likely find an elevation of human chorionic gonadotropin (hCG)?
In which type of cancer would you most likely find an elevation of human chorionic gonadotropin (hCG)?
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Which tumor marker is specifically elevated in neuroendocrine tumors such as neuroblastoma?
Which tumor marker is specifically elevated in neuroendocrine tumors such as neuroblastoma?
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Which condition is associated with extreme elevations of alpha-fetoprotein (AFP) greater than 500 ng/ml?
Which condition is associated with extreme elevations of alpha-fetoprotein (AFP) greater than 500 ng/ml?
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Which of the following markers is classified as a carbohydrate antigen?
Which of the following markers is classified as a carbohydrate antigen?
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Which statement accurately describes malignant tumors?
Which statement accurately describes malignant tumors?
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What distinguishes benign tumors from malignant tumors?
What distinguishes benign tumors from malignant tumors?
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What is the primary mechanism that allows cancer cells to invade surrounding tissues?
What is the primary mechanism that allows cancer cells to invade surrounding tissues?
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Which stage of cancer is characterized by spread to distant sites?
Which stage of cancer is characterized by spread to distant sites?
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What defines a tumor marker?
What defines a tumor marker?
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Which of the following methods is NOT typically used to diagnose neoplasia?
Which of the following methods is NOT typically used to diagnose neoplasia?
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In what condition are tumor markers likely to be measured?
In what condition are tumor markers likely to be measured?
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What type of tumor is an angioma?
What type of tumor is an angioma?
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Which of the following types of tumor markers involves proteins found on the surface of cancer cells?
Which of the following types of tumor markers involves proteins found on the surface of cancer cells?
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What characteristic would ideally define a perfect tumor marker?
What characteristic would ideally define a perfect tumor marker?
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Which of the following is a biochemical method used to measure tumor markers?
Which of the following is a biochemical method used to measure tumor markers?
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What kind of conditions can lead to false positive results for tumor markers?
What kind of conditions can lead to false positive results for tumor markers?
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Which of the following might cause false negative results in tumor marker tests?
Which of the following might cause false negative results in tumor marker tests?
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What does an elevated level of prostate-specific antigen (PSA) indicate?
What does an elevated level of prostate-specific antigen (PSA) indicate?
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Why is CA125 not used as a routine test for ovarian cancer?
Why is CA125 not used as a routine test for ovarian cancer?
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Which statement is true about the ideal characteristics of tumor markers?
Which statement is true about the ideal characteristics of tumor markers?
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What are the limitations of using tumor markers in cancer diagnosis?
What are the limitations of using tumor markers in cancer diagnosis?
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What is the primary use of CA125 in clinical practice?
What is the primary use of CA125 in clinical practice?
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Which of the following is NOT a type of tumor marker?
Which of the following is NOT a type of tumor marker?
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Which of the following is true about the tumor markers ESR and LDH?
Which of the following is true about the tumor markers ESR and LDH?
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What can tumor markers help determine in patients with cancer?
What can tumor markers help determine in patients with cancer?
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Which of the following tumor markers is commonly associated with prostate cancer?
Which of the following tumor markers is commonly associated with prostate cancer?
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Which tumor marker can indicate both malignant causes and benign conditions, making it less specific?
Which tumor marker can indicate both malignant causes and benign conditions, making it less specific?
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What is the significance of combining various tumor markers in cancer diagnosis?
What is the significance of combining various tumor markers in cancer diagnosis?
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What is the primary function of prostate-specific antigen (PSA)?
What is the primary function of prostate-specific antigen (PSA)?
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Which hormone is produced by an islet cell tumor?
Which hormone is produced by an islet cell tumor?
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What limitation does PSA have as a screening tool for prostate cancer?
What limitation does PSA have as a screening tool for prostate cancer?
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Which cancer is associated with elevated levels of lactate dehydrogenase (LDH)?
Which cancer is associated with elevated levels of lactate dehydrogenase (LDH)?
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Which of the following is NOT mentioned as a function of human chorionic gonadotropin (HCG)?
Which of the following is NOT mentioned as a function of human chorionic gonadotropin (HCG)?
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Which advancement in tumor markers is mentioned for early disease identification?
Which advancement in tumor markers is mentioned for early disease identification?
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What characteristic of PSA enhances its utility in prostate cancer diagnosis?
What characteristic of PSA enhances its utility in prostate cancer diagnosis?
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Which of these markers is appropriate for the assessment of liver metastasis?
Which of these markers is appropriate for the assessment of liver metastasis?
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Study Notes
Cancer and Tumor Markers
- Cancer is the uncontrolled growth and spread of abnormal cells in the body.
- Cancer is a group of more than 200 different diseases.
- Cancer is identified by uncontrolled cell growth and proliferation.
- Initially, a tumor cell may be located and contained (benign).
- Invasive tumor cells spread into surrounding tissue and blood vessels.
Malignant Tumors
- Malignant tumors are cancers. Tumor cells invade and damage tissues and organs nearby.
- Mutations in benign cells allow for invasion of tissues and spread to other parts of the body (metastasis).
- Examples of how malignant tumor cells behave differently than normal cells include:
- Decreased cell-cell interactions and adhesion within the affected tissues.
- Increased production of proteases to aid in the movement of abnormal cells through tissues.
Benign Tumors
- Benign tumors are not cancer.
- They can be removed and in most cases do not return.
- Most importantly, cells from benign tumors stay in one location and do not spread.
- Examples of benign tumors:
- Adenoma (glands)
- Myoma (muscle tissue)
- Lipoma (fatty tissue)
- Angioma (small blood or lymph vessels-e.g. a birthmark)
- Chondroma (cartilage)
Characteristics of Benign and Malignant Tumors
| Characteristic | Benign | Malignant |
|---|---|---|
| Differentiation | Tumor cells resemble original mature cells | Tumor cells may not resemble original mature cells |
| Growth Rate | Slow; might stop or regress | Rapid, autonomous; usually does not stop or regress |
| Type of Growth | Expand and displace | Invade, destroy, and replace |
| Metastasis | No | Yes |
| Health Effect | Usually does not cause death | May cause death if not diagnosed and treated |
Stages of Cancer
- Stage 1: Confined to organ of origin.
- Stage 2: Locally invasive.
- Stage 3: Spread to lymph nodes.
- Stage 4: Spread to distant sites.
Tumor Markers
- A tumor marker is a substance (protein, enzyme, etc.) produced by a tumor or the host in response to a tumor.
- Tumor markers can be used to differentiate a tumor from normal tissue.
- Tumor markers can be used to detect the presence of a tumor.
- Tumor markers include substances found in cells, tissues, or body fluids.
- These substances can be measured qualitatively or quantitatively using chemical, immunological, or molecular diagnostic methods.
- Tumor cells multiplying, cancer spreading, and tissue damage causes an increase and release of tumor markers into the bloodstream.
- The measurement of tumor markers is useful in tumor diagnosis.
- The measurement of tumor markers is used to follow the efficiency of treatment.
- The measurement of tumor markers can be used to predict the response to therapy.
Diagnostic Methods for Neoplasia
- Family history and direct examination (symptoms like weight loss, fatigue, etc.)
- Radiographic techniques (x-rays, CT, MRI, Mammography, Ultrasound, PET scan.)
- Pathological diagnostic procedures (FNA, biopsy, cytological smears)
- Biochemical assays and genetic methods (tumor markers)
Methods used to measure Tumor Markers
- Immunoassays (e.g., ELISA)
- HPLC
- Immunohistochemistry
- Enzyme assays
- Molecular biology methods
Types of Tumor Markers
- Cell surface antigens
- Cytoplasmic proteins
- Enzymes
- Hormones
- Oncofetal antigens
- Receptors
- RNA or DNA biomarkers
- Gene expression markers
The Ideal Tumor Marker
- Specific for a tumor (few markers specific for individual tumors).
- Sensitive: detect small tumors to allow early diagnosis or screening.
- Level should change in response to tumor size.
- Levels in healthy individuals are much lower than in cancer.
- Easily and reproducibly measured.
- Determination is not expensive.
- No known tumor marker has 100% sensitivity and specificity.
- In practice, tumor markers are most useful in evaluating disease progression after initial therapy and monitoring subsequent treatment.
Urinary Tumor Markers
- Various urinary markers are associated with various malignancies (e.g., Polyamines, Vanillylmandelic acid, etc.)
CSF Tumor Markers
- Tumor markers in cerebrospinal fluid (CSF) are linked to malignancies that have metastasized to the central nervous system (CNS).
False Results in Tumor Markers
- False Positive Results:*
- Inflammatory conditions
- Benign conditions
- Liver diseases (affect metabolism and excretion of tumor markers)
- Renal function disturbances
- Physiological conditions (pregnancy)
- False Negative Results:*
- Insufficient expression of antigen in tumor cells
- Insufficient blood circulation in the tumor
- Rapid antigen degradation
Limitations of the Use of Tumor Markers
- Tumor markers are not ideal for diagnosing cancer
- False positive results: individuals without cancer may have elevated levels of the marker.
- False negative results: tumor markers may not be sufficiently elevated in all individuals with cancer.
- Examples of false results: Prostate-specific antigen (PSA) is elevated in benign prostate hypertrophy, so additional testing is needed.
More Accurate Tumor Markers
- Patterns of gene expression and changes in DNA sequences are increasingly used as tissue-specific markers.
- Proteomics (the study of protein structure, function and patterns of expression) to develop biomarkers for early disease identification, effectiveness of treatment, and recurrence prediction.
Advances in Tumor Biomarkers
- Genomics and proteomics approaches
- Complementary DNA (cDNA)
- microRNA (miRNA) biomarkers
- Long non-coding RNA (LncRNA) biomarkers
- Protein, and tissue microarray
- Mass spectrometry (MS)
- Bioinformatics tools
- Serum proteomics
Selected Molecular Markers of Cancer
- Various markers (DNA, RNA, protein) are associated with specific cancers.
Common Serum Markers for Cancer Diagnosis/Prognosis
- A table showing which serum markers are associated with various cancers
Tumor Markers Used for Cancer Treatment
- Determining the effectiveness of cancer treatment
- Detecting tumor recurrence or remission
Some Common Tumor Markers
- Table showing analyte and cancer use for common markers (e.g., CEA, CA-125, CA15-3, AFP, total PSA, free PSA, hCG, hormone receptors)
Tumor Marker Descriptions
- Various tumor markers (alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (B-HCG), carbohydrate antigen 125 (CA 125), carbohydrate antigen 19-9 (CA 19-9), carbohydrate antigen 15-3 (CA 15-3), carcinoembryonic antigen (CEA), lactate dehydrogenase (LD) are described with their corresponding conditions and cancer types.
Classification of Tumor Markers
- Oncofetal proteins (e.g., AFP, hCG, CEA)
- Carbohydrate antigens (e.g., CA-125, CA-19-9)
- Enzymes (e.g., ALP, LDH, amylase, creatine kinase, PSA, PAP)
- Hormones and hormone receptors
- Proteins (e.g., B2-microglobulin, ferritin)
- Genetic markers (e.g., mutated oncogenes, tumor suppressor genes)
Oncofetal proteins (e.g., Alpha-fetoprotein (AFP)
- AFP is a fetal serum protein.
- AFP levels are normally low in adults.
- Elevated AFP levels are associated with hepatocellular carcinoma (HCC) and other conditions like acute hepatitis.
Enzymes as Tumor Markers
- Alkaline phosphatase (ALP) is associated with liver, bone, and placenta.
- Lactate dehydrogenase (LDH) is nonspecific and found in various cancers including liver and leukemia.
Prostate-Specific Antigen (PSA)
- PSA is the only marker used for screening prostate cancer.
- Tissue-specific marker found in prostate epithelium.
- PSA function: semen liquefaction.
- Highly sensitive marker for prostate cancer.
- Elevation is linked to stage, tumor size, recurrence, and response to treatment.
- Elevated in benign conditions (e.g., benign prostatic hyperplasia).
Hormones (examples)
- Insulin, calcitonin, catecholamines, ectopic ACTH and ADH from lung cancers
- Human chorionic gonadotropin (hCG): pregnancy, elevated levels associated with cancers
- Important Note: Tumor markers are not ideal markers for diagnosis and need to be interpreted with other diagnostic tools.
In Conclusion
- No serum marker is specific for malignancy at present.
- Markers are rarely elevated in early-stage malignancy.
- Markers are good for monitoring response to treatment and recurrence.
- Cancer markers are most useful in combination with comprehensive medical evaluations.
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Description
This quiz covers the fundamentals of cancer, including the differences between benign and malignant tumors. It explores how tumor cells behave, their impact on surrounding tissues, and the concept of metastasis. Test your knowledge on the characteristics and identification of cancerous growths.
