Cancer Biology: Tumor Markers

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Questions and Answers

What is the primary source of Cancer Antigen 125 (CA 125)?

Breast cancer cells

Ovarian cancer cells (correct)

Pancreatic cancer cells

Prostate cancer cells

What is the cut-off value of CA 15.3?

30 units/ml

35 units/ml (correct)

40 units/ml

45 units/ml

What is the normal level of PSA?

0-4 ng/ml (correct)

0-8 ng/ml

0-2 ng/ml

0-6 ng/ml

What is the upper limit of normal CA 50?

23 units/ml Signup and view all the answers

What is the cut-off value of PAP?

0.5-11 units/liter Signup and view all the answers

What is the primary use of LDH?

Monitoring leukemia and lymphoma Signup and view all the answers

What precautions should be taken before taking serum samples for PAP assay?

Avoiding rectal examination and passage of catheter at least 7 days before sampling Signup and view all the answers

What is the type of CA 50?

Glycolipid Signup and view all the answers

What is the primary function of tumor markers in cancer diagnosis?

To screen for the presence of malignancy Signup and view all the answers

What is the significance of tumor markers in tissues?

To identify the presence of cancer cells Signup and view all the answers

What is the ideal property of a tumor marker?

High disease sensitivity Signup and view all the answers

What is the clinical importance of tumor markers in cancer patients?

For diagnosis, screening, staging, monitoring, and prognosis Signup and view all the answers

Where can tumor markers be present?

In the cytoplasm or on cell membrane, in tissue, circulation, and body fluids Signup and view all the answers

What is the role of tumor markers in staging?

Determining the level of disease Signup and view all the answers

What is the significance of tumor markers in monitoring therapy?

Estimating the response of therapy Signup and view all the answers

What is the structure of tumor markers?

Enzymes, hormones, and proteins (tumor antigen) Signup and view all the answers

What is the primary function of Alpha Feto Protein (AFP) in early fetal life?

To serve as a major serum protein Signup and view all the answers

What is the cut-off value of AFP in non-neoplastic conditions?

2-11 ng/ml Signup and view all the answers

What is the normal range of CEA in the blood of most healthy people?

Below 5 ng/ml Signup and view all the answers

What is the primary use of CA 19-9 test?

To monitor a person's response to treatment for pancreatic cancer Signup and view all the answers

What is the origin of Carbohydrate Antigen 19-9?

It is found on the surface of certain cancer cells Signup and view all the answers

Which of the following cancers is associated with elevated levels of AFP?

Hepatocellular carcinoma and testicular carcinoma Signup and view all the answers

What is the normal range of CEA in the blood of healthy people?

Below 5 ng/ml Signup and view all the answers

Which of the following is a non-neoplastic condition associated with elevated levels of AFP?

Tissue injury Signup and view all the answers

What is the primary function of intact skin in innate immunity?

To act as a physical barrier Signup and view all the answers

Macrophages are only present in the liver and spleen.

False Signup and view all the answers

What is the function of phagocytes in innate immunity?

To recognize and ingest microbes for intracellular killing Signup and view all the answers

The most abundant leukocytes in the blood are ______________.

neutrophils Signup and view all the answers

Which of the following is a type of soluble factor in innate immunity?

Complement Signup and view all the answers

Monocytes are more abundant than neutrophils in the blood.

False Signup and view all the answers

What is the function of lysozymes in innate immunity?

To provide biochemical defenses Signup and view all the answers

Acute phase proteins include ______________.

CRP Signup and view all the answers

Match the following components of innate immunity with their functions:

Intact skin = Acts as a physical barrier Phagocytes = Recognizes and ingests microbes Natural killer cells = Recognizes and kills infected cells Soluble factors = Provides biochemical defenses Signup and view all the answers

Neutrophils can survive in extravascular tissues for long periods.

False Signup and view all the answers

What is the function of macrophages in the host defense?

All of the above Signup and view all the answers

Phagocytosis is a process in which the phagocyte extends its plasma membrane around the microbes, and the membrane closes up and pinches off, forming a phagosome.

True Signup and view all the answers

What is the function of Phagocyte Oxidase enzyme?

Converts molecular oxygen into superoxide anion and free radicals, which are toxic to ingested microbes. Signup and view all the answers

The deficiency of ____________ enzyme is the cause of an immunodeficiency disease called Chronic Granulomatous Disease (CGD).

Phagocyte Oxidase Signup and view all the answers

Match the following enzymes with their functions:

Phagocyte Oxidase = Convert molecular oxygen into superoxide anion Nitric Oxide Synthase = Convert arginine to nitric oxide Lysosomal Proteases = Break down microbial proteins Signup and view all the answers

What is the result of an inherited deficiency of Phagocyte Oxidase enzyme?

Chronic Granulomatous Disease (CGD) Signup and view all the answers

Macrophages can stimulate T lymphocytes and respond to products of T cells.

True Signup and view all the answers

What is the function of macrophages in remodeling injured tissue?

They secrete growth factors and enzymes that serve to remodel injured tissue and replace it with connective tissue. Signup and view all the answers

Macrophages are found in every organ in the body and in the _______________ tissues.

connective Signup and view all the answers

Phagolysosomes are formed by the fusion of phagosomes with lysosomes.

True Signup and view all the answers

What is the primary function of Natural Killer (NK) cells?

To recognize and kill infected cells Signup and view all the answers

Interferons are produced by virally infected cells and sometimes by lymphocytes.

True Signup and view all the answers

What is the function of Lysozyme?

Breaks cell wall peptidoglycan of bacteria where it cleavages the bridge between N-acetylglucosamine (GlcNac) and N-acetylmuramic acid (MurNac). Signup and view all the answers

CRP stands for _______________________.

C reactive protein Signup and view all the answers

Match the following components of the innate immune system with their functions:

Interferons = Activate NK cells and induce viral resistance in uninfected cells Lysozyme = Breaks cell wall peptidoglycan of bacteria Complement = Mediates a cascade of enzymatic reactions leading to target cell lysis and enhanced phagocytosis Signup and view all the answers

What is the primary function of C-reactive protein (CRP)?

To facilitate opsonization of bacteria Signup and view all the answers

Cytokines of innate immunity stimulate inflammation.

True Signup and view all the answers

What is the function of IL-12?

Activate NK cells Signup and view all the answers

IFN-γ _______________________ macrophages.

activates Signup and view all the answers

What is the role of cytokines of innate immunity in adaptive immunity?

To provide "second signals" for the activation of B and T lymphocytes Signup and view all the answers

What is the function of macrophages in remodeling injured tissue?

Secrete growth factors and enzymes to replace injured tissue with connective tissue Signup and view all the answers

Macrophages are only found in the liver and spleen.

False Signup and view all the answers

What is the process called when a phagocyte extends its plasma membrane around the microbes, and the membrane closes up and pinches off?

Phagocytosis Signup and view all the answers

The deficiency of ____________________ enzyme is the cause of an immunodeficiency disease called Chronic Granulomatous Disease (CGD).

Phagocyte Oxidase Signup and view all the answers

What is the function of Nitric Oxide Synthase enzyme?

Conversion of arginine to nitric oxide (NO) Signup and view all the answers

Phagolysosomes are formed by the fusion of lysosomes with phagosomes.

True Signup and view all the answers

What is the function of macrophages in the host defense?

Produce cytokines, stimulate T lymphocytes and respond to products of T cells Signup and view all the answers

Match the following enzymes with their functions:

Phagocyte Oxidase = Converts molecular oxygen into superoxide anion Nitric Oxide Synthase = Breakdown of microbial proteins Lysosomal Proteases = Conversion of arginine to nitric oxide (NO) Signup and view all the answers

Macrophages are found in every organ in the body and in the ____________________ tissues.

connective Signup and view all the answers

What is the result of an inherited deficiency of Phagocyte Oxidase enzyme?

Phagocytes are unable to eradicate intracellular microbes Signup and view all the answers

Which of the following is a component of innate immunity?

Intact skin Signup and view all the answers

Monocytes are more abundant than neutrophils in the blood.

False Signup and view all the answers

What is the function of phagocytes in innate immunity?

To recognize and ingest microbes for intracellular killing. Signup and view all the answers

The importance of intact skin as a physical barrier becomes clear when an individual suffers from ______________________.

serious burns Signup and view all the answers

Which of the following soluble factors is involved in innate immunity?

Interferons Signup and view all the answers

Neutrophils can survive in extravascular tissues for long periods.

False Signup and view all the answers

Match the following components of innate immunity with their functions:

Intact skin = Physical barrier against infection Phagocytes = Recognize and ingest microbes for intracellular killing Natural Killer (NK) cells = Direct killing of infected cells Cytokines = Activate immune cells and coordinate immune response Signup and view all the answers

What is the function of lysozymes in innate immunity?

To break down bacterial cell walls. Signup and view all the answers

Macrophages are found in every organ in the body and in the ______________________ tissues.

connective Signup and view all the answers

What is the primary function of Natural Killer (NK) cells?

Direct killing of infected cells Signup and view all the answers

What is the primary function of Natural Killer (NK) cells?

To recognize and kill infected cells Signup and view all the answers

Lysozyme breaks down the cell wall of bacteria by cleaving the bridge between N-acetylglucosamine and N-acetylmuramic acid.

True Signup and view all the answers

What is the function of CRP?

CRP binds to bacteria and promotes complement activation, facilitating their uptake by phagocytes. Signup and view all the answers

Interferons are produced by _______________ cells and sometimes by lymphocytes.

virally infected Signup and view all the answers

What is the function of interleukin-12 (IL-12)?

To activate NK cells Signup and view all the answers

Complement activation leads to the lysis of target cells.

True Signup and view all the answers

What is the function of cytokines in innate immunity?

Cytokines stimulate inflammation, activate NK cells and macrophages, and prevent viral infections. Signup and view all the answers

Match the following components of innate immunity with their functions:

Interferons = Prevent viral infections Lysozyme = Breaks down bacterial cell walls CRP = Promotes complement activation and phagocytosis Cytokines = Stimulate inflammation, activate NK cells and macrophages Signup and view all the answers

Macrophages that have encountered microbes activate NK cells through _______________.

cytokines Signup and view all the answers

NK cells are a type of soluble factor in innate immunity.

False Signup and view all the answers

Study Notes

Definition and Importance of Tumor Markers

Tumor markers (TM) are biologic substances synthesized and released by cancer cells or produced by host cells in response to cancer presence.
Ideal tumor markers should provide diagnosis, screening, staging, monitoring, assessing prognosis, and detecting recurrence.

Properties of Ideal Tumor Markers

Have high disease sensitivity and specificity.
Can detect micro-metastasis after curative therapy.
Can detect early disease recurrence.

Types and Classification of Tumor Markers

Classification of tumor markers includes:
- Oncofetal antigens (e.g., AFP, CEA)
- Cancer-associated antigens (e.g., CA 125, CA 15.3, CA 19-9)
- Hormones (e.g., estrogen receptor)
- Enzymes (e.g., LDH, PAP)
- Proteins (e.g., B2 macroglobulin, Ferritin)

Examples of Clinically Important Tumor Markers

CA 125 (Cancer Antigen 125)

Produced by ovarian cancer cells.
Found in trace amounts in healthy adults.
Highly specific tumor marker for ovarian cancer.

CA 15.3 (Cancer Antigen 15.3)

Highly specific tumor marker for breast cancer.
Provides prognostic information in breast cancer management.
Cut-off value: 35 units/ml.

CA 50 (Cancer Antigen 50)

A glycolipid.
Monitors disease and therapy effectiveness for pancreatic carcinoma.
Upper limit of normal: 23 units/ml.

PSA (Prostatic Specific Antigen)

Produced only by prostatic epithelial cells.
Elevated levels (>4 ng/ml) in prostatic cancer and benign prostatic hypertrophy.
Normal level: 0-4 ng/ml.

PAP (Prostatic Acid Phosphatase)

Elevated serum levels in prostatic carcinoma.
Precautions: avoid rectal examination and passage of catheter before sampling.
Cut-off value: 0.5-11 units/liter.

LDH (Lactate Dehydrogenase)

Elevated levels in leukemia and lymphoma.

AFP (Alpha Fetoprotein)

Produced in early fetal life.
Elevated levels (>500 ng/ml) in hepatocellular carcinoma and testicular carcinoma.
Cut-off value: 2-11 ng/ml.

CEA (Carcinoembryonic Antigen)

Normally found in small amounts in healthy adult blood.
Elevated levels (>5 ng/ml) in colonic cancer and some lung, pancreas, uterus, and breast tumors.
Cut-off value: 5 ng/ml.

CA 19-9 (Carbohydrate Antigen 19-9)

Found on certain cancer cells and in small amounts in pancreas, liver, gallbladder, and lungs of healthy adults.
Used to monitor pancreatic cancer treatment response.

Mononuclear Phagocyte System

Monocytes in the blood differentiate into macrophages in tissues, which are two stages of the same cell lineage
Resident macrophages are found in connective tissues and every organ in the body

Functions of Macrophages

Produce cytokines that are important mediators of host defense
Secrete growth factors and enzymes to remodel injured tissue and replace it with connective tissue
Stimulate NK cells by secretion of IL-12
Stimulate T lymphocytes and respond to products of T cells

Phagocytosis

A process in which the phagocyte extends its plasma membrane around the microbe, closes up, and pinches off, forming a phagosome
Phagosomes fuse with lysosomes to form phagolysosomes
Enzymes are activated in phagolysosomes, including:
- Phagocyte Oxidase, which converts molecular oxygen into superoxide anion and free radicals
- Nitric Oxide Synthase, which catalyzes the conversion of arginine to nitric oxide (NO)
- Lysosomal Proteases, which break down microbial proteins

Chronic Granulomatous Disease (CGD)

An inherited deficiency of phagocyte Oxidase enzyme
Phagocytes are unable to eradicate intracellular microbes
Host tries to contain the infection by calling in more macrophages and lymphocytes, resulting in collections of cells around microbes called granulomas

Components of Innate Immunity

Intact skin
- Acts as a physical barrier
- Importance of this barrier becomes clear when individual suffers serious burns
Phagocytes (Neutrophils, Monocytes, Macrophages)
- Bone marrow delivers blood monocytes which differentiate into macrophages in tissues
- Phagocytic cells, e.g. brain microglial cells, liver Kupffer cells, kidney mesangial phagocytic cells, synovial A cells
- Circulating phagocytes (Neutrophils & Monocytes) recognize and ingest microbes for intracellular killing
Natural killer (NK) cells
- Recognize cell surface changes or virally-infected cells and kill them
- Produce cytokine, interferon-γ (IFN-γ), which activates macrophages
Soluble factors
- Interferons
  - Produced by virally infected cells and sometimes by lymphocytes
  - Activate NK cells and induce a state of viral resistance in uninfected cells
- Lysozyme
  - Breaks cell wall peptidoglycan of bacteria
- Acute phase proteins
  - Produced during infection, e.g. CRP (C-reactive protein)
  - Function of CRP: binds to bacteria, promotes complement activation, and facilitates phagocytosis
- Complement
  - Mediates a cascade of enzymatic reactions leading to target cell lysis and enhanced phagocytosis (opsonization)
- Cytokines of innate immunity
  - Stimulate inflammation, activate NK cells, activate macrophages, and prevent viral infections

Mononuclear Phagocyte System

Monocytes in the blood differentiate into macrophages in tissues, which are two stages of the same cell lineage
Resident macrophages are found in connective tissues and every organ in the body

Functions of Macrophages

Produce cytokines that are important mediators of host defense
Secrete growth factors and enzymes to remodel injured tissue and replace it with connective tissue
Stimulate NK cells by secretion of IL-12
Stimulate T lymphocytes and respond to products of T cells

Phagocytosis

A process in which the phagocyte extends its plasma membrane around the microbe, closes up, and pinches off, forming a phagosome
Phagosomes fuse with lysosomes to form phagolysosomes
Enzymes are activated in phagolysosomes, including:
- Phagocyte Oxidase, which converts molecular oxygen into superoxide anion and free radicals
- Nitric Oxide Synthase, which catalyzes the conversion of arginine to nitric oxide (NO)
- Lysosomal Proteases, which break down microbial proteins

Chronic Granulomatous Disease (CGD)

An inherited deficiency of phagocyte Oxidase enzyme
Phagocytes are unable to eradicate intracellular microbes
Host tries to contain the infection by calling in more macrophages and lymphocytes, resulting in collections of cells around microbes called granulomas

Components of Innate Immunity

Intact skin
- Acts as a physical barrier
- Importance of this barrier becomes clear when individual suffers serious burns
Phagocytes (Neutrophils, Monocytes, Macrophages)
- Bone marrow delivers blood monocytes which differentiate into macrophages in tissues
- Phagocytic cells, e.g. brain microglial cells, liver Kupffer cells, kidney mesangial phagocytic cells, synovial A cells
- Circulating phagocytes (Neutrophils & Monocytes) recognize and ingest microbes for intracellular killing
Natural killer (NK) cells
- Recognize cell surface changes or virally-infected cells and kill them
- Produce cytokine, interferon-γ (IFN-γ), which activates macrophages
Soluble factors
- Interferons
  - Produced by virally infected cells and sometimes by lymphocytes
  - Activate NK cells and induce a state of viral resistance in uninfected cells
- Lysozyme
  - Breaks cell wall peptidoglycan of bacteria
- Acute phase proteins
  - Produced during infection, e.g. CRP (C-reactive protein)
  - Function of CRP: binds to bacteria, promotes complement activation, and facilitates phagocytosis
- Complement
  - Mediates a cascade of enzymatic reactions leading to target cell lysis and enhanced phagocytosis (opsonization)
- Cytokines of innate immunity
  - Stimulate inflammation, activate NK cells, activate macrophages, and prevent viral infections

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Description

Learn about the definition, clinical importance, properties, and types of tumor markers in cancer biology. This lecture covers the essential concepts of tumor markers, including examples of clinically important ones.