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Questions and Answers
What is the primary role of the tumor marker CA-125 in ovarian cancer?
What is the primary role of the tumor marker CA-125 in ovarian cancer?
In which of the following conditions would CA-125 levels be elevated besides ovarian cancer?
In which of the following conditions would CA-125 levels be elevated besides ovarian cancer?
Which characteristic is associated with the use of CA-125 as a tumor marker?
Which characteristic is associated with the use of CA-125 as a tumor marker?
Which of the following tumor markers can be used alongside CA-125 for monitoring ovarian cancer therapy?
Which of the following tumor markers can be used alongside CA-125 for monitoring ovarian cancer therapy?
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What is a limitation of using CA-125 as a tumor marker in ovarian cancer?
What is a limitation of using CA-125 as a tumor marker in ovarian cancer?
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What is the primary use of CA-125 in cancer management?
What is the primary use of CA-125 in cancer management?
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Which of the following conditions can lead to elevated CA-125 levels?
Which of the following conditions can lead to elevated CA-125 levels?
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What other tumor marker is mentioned alongside CA-125 for ovarian carcinoma?
What other tumor marker is mentioned alongside CA-125 for ovarian carcinoma?
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In what situation is CA-125 most effectively utilized?
In what situation is CA-125 most effectively utilized?
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Which of the following is NOT a cause of elevated CA-125 levels?
Which of the following is NOT a cause of elevated CA-125 levels?
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CA-125 is particularly useful in evaluating which specific type of cancer?
CA-125 is particularly useful in evaluating which specific type of cancer?
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What is the significance of serial estimation of CA-125 levels?
What is the significance of serial estimation of CA-125 levels?
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How can CA-125 levels impact treatment decisions for ovarian cancer patients?
How can CA-125 levels impact treatment decisions for ovarian cancer patients?
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What percentage of CA-125 concentration elevation is typically associated with epithelial ovarian carcinoma (OC)?
What percentage of CA-125 concentration elevation is typically associated with epithelial ovarian carcinoma (OC)?
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Which of the following statements about CA-125 is correct?
Which of the following statements about CA-125 is correct?
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What is the primary concern when CA-125 levels are elevated?
What is the primary concern when CA-125 levels are elevated?
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In which condition might CA-125 also be raised besides ovarian carcinoma?
In which condition might CA-125 also be raised besides ovarian carcinoma?
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Which of the following is a limitation of the CA-125 test?
Which of the following is a limitation of the CA-125 test?
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What is the role of CA-125 in managing ovarian carcinoma?
What is the role of CA-125 in managing ovarian carcinoma?
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Which of the following is true regarding the elevation of CA-125 in different populations?
Which of the following is true regarding the elevation of CA-125 in different populations?
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How does the use of CA-125 in monitoring patients compare to other cancer markers?
How does the use of CA-125 in monitoring patients compare to other cancer markers?
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Study Notes
Tumor Markers
- CA-125 is a tumor marker that is often raised in ovarian carcinoma (epithelial OC - 80%).
- CA-125 can also be raised during pregnancy, due to fibroids, liver and pancreatic disease, endometriosis, pelvic inflammatory disease, and other malignant diseases (lung, breast, colon carcinoma).
- Human epididymis protein 4 (HE4) is a tumor marker for ovarian carcinoma and can also be overexpressed in endometrial cancer.
- Combined CA-125 and HE4 levels may be used in conjunction with ultrasound scans to aid with screening for ovarian carcinoma in high-risk individuals.
- **These markers are determined both before and after treatment for monitoring. **
Breast Cancer
- CA 15-3 levels can be raised in advanced breast carcinoma along with liver cirrhosis and ovarian cysts.
- Family history of breast cancer (BC) is a significant indicator of increased risk.
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BRCA1 and BRCA2 mutations are associated with a higher risk of breast cancer (BC) and ovarian cancer (OC).
- BRCA1 mutations are also linked higher risk of colon and prostate cancer.
- BRCA1 mutations account for 5% of BC and OC.
- BRCA2 mutations account for 3% of BC and OC.
Estrogen Receptor (ER) and Progesterone Receptor (PR)
- ER and PR assays are crucial for assessing prognosis in breast cancer.
- ER and PR levels in tissue excised during surgery help determine individualized treatment strategies.
Her2
- Her2 is overexpressed in 25-30% of breast cancers.
- Patients with positive ER and PR responses often benefit from endocrine therapy.
CA-19-9
- CA-19-9 may be elevated in patients with pancreatic or colorectal carcinoma, or obstructive liver disease.
- CA-19-9 levels may also be raised in hepatic, thyroid, pulmonary disease, and diabetes mellitus (DM).
Thyroid Cancers
- Thyroglobulin * is a high-molecular-weight protein produced by the follicular cells of the thyroid. High levels are seen in follicular or papillary carcinoma of the thyroid.
- Thyroglobulin antibodies should be measured to assess the potential for reduced thyroglobulin levels.
- Calcitonin is a hormone secreted by parafollicular C-cells of the thyroid gland.
- Elevated Calcitonin levels are indicative of medullary thyroid carcinoma (MTC).
- Calcitonin levels can be elevated before any clinical evidence of a tumor.
- Hereditary MTC may be screened for with a calcitonin stimulation test.
Other Tumor Markers
- Serum paraprotein and urinary Bence Jones proteins are markers for multiple myeloma.
- Plasma lactate dehydrogenase (LDH) activity may be raised in certain hematological conditions, such as lymphomas.
Prostate Specific Antigen (PSA)
- The PSA index, which represents the percentage of free PSA among total PSA, is suggestive of BPH if above 17%, and prostate carcinoma if below 17%.
- Elevated plasma PSA can indicate carcinoma, even within the reference range.
- Plasma PSA levels above 20 μg/L suggest prostatic carcinoma that has spread beyond the prostate gland.
- PSA assays and digital rectal exams are used within screening programs for prostatic carcinoma in at-risk males.
- There is no universally agreed upon screening protocol for prostatic carcinoma in the general population.
- Prostate biopsy is generally indicated for PSA concentrations above 10 μg/L.
Carcinoembryonic Antigen (CEA)
- CEA is produced by various malignant tumors, especially colorectal carcinomas.
- Serial CEA estimations help monitor the effectiveness of treatment and detect recurrence.
- Plasma concentrations of CEA may be unreliable in determining tumor mass.
- High CEA concentrations often are associated with a poor prognosis.
- **CEA may also be elevated in non-malignant gastrointestinal tract conditions and in smokers, limiting its specificity. **
α-Fetoprotein (AFP)
- AFP synthesis is suppressed as the fetus matures.
- High AFP levels are observed in patients with hepatocellular carcinoma (primary hepatomas and hepatoblastomas) and teratoma.
- Moderately raised AFP levels can be due to non-malignant liver disease.
Human Chorionic Gonadotropin (hCG)
- hCG is mainly produced by the placenta, but also by trophoblastic cells of gonadal and extragonadal germ cell tumors.
- Ectopic secretion of hCG can occur in some bronchial carcinomas.
- hCG estimations are used to screen for choriocarcinoma in women who have experienced a hydatidiform mole.
- High hCG levels can indicate malignancy of the gonads, such as seminomas.
- hCG levels are used to monitor response to treatment and tumor recurrence.
Placental Alkaline Phosphatase (PLAP)
- PLAP and placental-like isoenzyme levels are elevated in seminoma and dysgerminoma.
- In combination with AFP and hCG, PLAP is useful for diagnosing and monitoring extragonadal and gonadal germ cell tumors.
- PLAP levels are also elevated in smokers.
- The concentration may be raised in the plasma of patients with ovarian carcinoma (OC) (80% of epithelial OC).
Other Tumor Markers
- Neuronal-specific enolase (NSE), a marker derived from neurodectal tissue, shows elevated plasma levels in small cell lung carcinoma and neuroblastoma.
- Inhibin, produced by the granulosa cells of the ovary and Sertoli cells of the testis, serves as a plasma tumor marker for ovarian granulosa cell tumors and testicular Sertoli cell tumors.
- Squamous cell carcinoma antigen is a potential plasma tumor marker for squamous cell carcinoma of the cervix.
- Chromogranin A is released from neuroendocrine cells, such as those found in phaeochromocytoma and carcinoid tumors.
- Protein S100B, expressed in brain astrocytes, glial cells, and melanocytes, may contribute to monitoring therapy for malignant melanoma.
Roles of Tumor Markers
- Determine risk (PSA)
- Screen for early cancer (Calcitonin, occult blood)
- Diagnose a type of cancer (hCG, catecholamines)
- Estimate prognosis (CA125)
- Predict response to therapy (CA15-3, CA125, PSA, hCG)
- Monitor for disease recurrence or progression (most widely used function)
- Therapeutic selection (Her2/neu, ER, PR)
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Description
This quiz explores key tumor markers such as CA-125, HE4, and CA 15-3, focusing on their roles in ovarian and breast cancer. It highlights the significance of family history and genetic mutations in assessing cancer risk. Test your knowledge on how these markers are used in diagnosis and monitoring.
