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?

    <p>23 units/ml</p> Signup and view all the answers

    What is the cut-off value of PAP?

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

    What is the primary use of LDH?

    <p>Monitoring leukemia and lymphoma</p> Signup and view all the answers

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

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

    What is the type of CA 50?

    <p>Glycolipid</p> Signup and view all the answers

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

    <p>To screen for the presence of malignancy</p> Signup and view all the answers

    What is the significance of tumor markers in tissues?

    <p>To identify the presence of cancer cells</p> Signup and view all the answers

    What is the ideal property of a tumor marker?

    <p>High disease sensitivity</p> Signup and view all the answers

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

    <p>For diagnosis, screening, staging, monitoring, and prognosis</p> Signup and view all the answers

    Where can tumor markers be present?

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

    What is the role of tumor markers in staging?

    <p>Determining the level of disease</p> Signup and view all the answers

    What is the significance of tumor markers in monitoring therapy?

    <p>Estimating the response of therapy</p> Signup and view all the answers

    What is the structure of tumor markers?

    <p>Enzymes, hormones, and proteins (tumor antigen)</p> Signup and view all the answers

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

    <p>To serve as a major serum protein</p> Signup and view all the answers

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

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

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

    <p>Below 5 ng/ml</p> Signup and view all the answers

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

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

    What is the origin of Carbohydrate Antigen 19-9?

    <p>It is found on the surface of certain cancer cells</p> Signup and view all the answers

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

    <p>Hepatocellular carcinoma and testicular carcinoma</p> Signup and view all the answers

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

    <p>Below 5 ng/ml</p> Signup and view all the answers

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

    <p>Tissue injury</p> Signup and view all the answers

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

    <p>To act as a physical barrier</p> Signup and view all the answers

    Macrophages are only present in the liver and spleen.

    <p>False</p> Signup and view all the answers

    What is the function of phagocytes in innate immunity?

    <p>To recognize and ingest microbes for intracellular killing</p> Signup and view all the answers

    The most abundant leukocytes in the blood are ______________.

    <p>neutrophils</p> Signup and view all the answers

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

    <p>Complement</p> Signup and view all the answers

    Monocytes are more abundant than neutrophils in the blood.

    <p>False</p> Signup and view all the answers

    What is the function of lysozymes in innate immunity?

    <p>To provide biochemical defenses</p> Signup and view all the answers

    Acute phase proteins include ______________.

    <p>CRP</p> Signup and view all the answers

    Match the following components of innate immunity with their functions:

    <p>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</p> Signup and view all the answers

    Neutrophils can survive in extravascular tissues for long periods.

    <p>False</p> Signup and view all the answers

    What is the function of macrophages in the host defense?

    <p>All of the above</p> 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.

    <p>True</p> Signup and view all the answers

    What is the function of Phagocyte Oxidase enzyme?

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

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

    <p>Phagocyte Oxidase</p> Signup and view all the answers

    Match the following enzymes with their functions:

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

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

    <p>Chronic Granulomatous Disease (CGD)</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    What is the function of macrophages in remodeling injured tissue?

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

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

    <p>connective</p> Signup and view all the answers

    Phagolysosomes are formed by the fusion of phagosomes with lysosomes.

    <p>True</p> Signup and view all the answers

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

    <p>To recognize and kill infected cells</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    What is the function of Lysozyme?

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

    CRP stands for _______________________.

    <p>C reactive protein</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

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

    <p>To facilitate opsonization of bacteria</p> Signup and view all the answers

    Cytokines of innate immunity stimulate inflammation.

    <p>True</p> Signup and view all the answers

    What is the function of IL-12?

    <p>Activate NK cells</p> Signup and view all the answers

    IFN-γ _______________________ macrophages.

    <p>activates</p> Signup and view all the answers

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

    <p>To provide &quot;second signals&quot; for the activation of B and T lymphocytes</p> Signup and view all the answers

    What is the function of macrophages in remodeling injured tissue?

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

    Macrophages are only found in the liver and spleen.

    <p>False</p> 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?

    <p>Phagocytosis</p> Signup and view all the answers

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

    <p>Phagocyte Oxidase</p> Signup and view all the answers

    What is the function of Nitric Oxide Synthase enzyme?

    <p>Conversion of arginine to nitric oxide (NO)</p> Signup and view all the answers

    Phagolysosomes are formed by the fusion of lysosomes with phagosomes.

    <p>True</p> Signup and view all the answers

    What is the function of macrophages in the host defense?

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

    Match the following enzymes with their functions:

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

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

    <p>connective</p> Signup and view all the answers

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

    <p>Phagocytes are unable to eradicate intracellular microbes</p> Signup and view all the answers

    Which of the following is a component of innate immunity?

    <p>Intact skin</p> Signup and view all the answers

    Monocytes are more abundant than neutrophils in the blood.

    <p>False</p> Signup and view all the answers

    What is the function of phagocytes in innate immunity?

    <p>To recognize and ingest microbes for intracellular killing.</p> Signup and view all the answers

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

    <p>serious burns</p> Signup and view all the answers

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

    <p>Interferons</p> Signup and view all the answers

    Neutrophils can survive in extravascular tissues for long periods.

    <p>False</p> Signup and view all the answers

    Match the following components of innate immunity with their functions:

    <p>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</p> Signup and view all the answers

    What is the function of lysozymes in innate immunity?

    <p>To break down bacterial cell walls.</p> Signup and view all the answers

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

    <p>connective</p> Signup and view all the answers

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

    <p>Direct killing of infected cells</p> Signup and view all the answers

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

    <p>To recognize and kill infected cells</p> 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.

    <p>True</p> Signup and view all the answers

    What is the function of CRP?

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

    Interferons are produced by _______________ cells and sometimes by lymphocytes.

    <p>virally infected</p> Signup and view all the answers

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

    <p>To activate NK cells</p> Signup and view all the answers

    Complement activation leads to the lysis of target cells.

    <p>True</p> Signup and view all the answers

    What is the function of cytokines in innate immunity?

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

    Match the following components of innate immunity with their functions:

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

    Macrophages that have encountered microbes activate NK cells through _______________.

    <p>cytokines</p> Signup and view all the answers

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

    <p>False</p> 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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