Tumor Markers in Cancer Management

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Questions and Answers

What defines a tumor marker?

A type of imaging technique used to detect tumors.

A biochemical substance produced by cancer cells or the body in response to cancer. (correct)

A biochemical substance synthesized by normal cells.

A genetic mutation exclusively associated with cancer.

Which characteristic is NOT a quality of a good tumor marker?

Should have a minimum plasma level in healthy subjects.

Should be present in healthy tissues. (correct)

Should have detectable levels even in small tumors.

Should be specific to a particular tissue.

In which locations can tumor markers be found?

Only in the blood circulation.

In skin and muscle tissues only.

Exclusively in the lymphatic system.

In body cavity fluids, cell membranes, and DNA. (correct)

What is an example of a carbohydrate epitope recognized by monoclonal antibodies?

CA 19-9 Signup and view all the answers

Why should the half-life of a tumor marker not be very long?

To facilitate prompt diagnosis and monitoring. Signup and view all the answers

How should the plasma level of a tumor marker correlate with tumor characteristics?

It should be proportional to both size and activity of the tumor. Signup and view all the answers

Which type of molecules can tumor markers be classified into?

Receptors, hormones, and enzymes. Signup and view all the answers

What is the significance of tumor markers in cancer management?

They assist in predicting the presence and recurrence of tumors. Signup and view all the answers

What is a primary requirement for a tumor marker to be used in screening asymptomatic individuals in the general population?

The marker should not be present in healthy individuals. Signup and view all the answers

Which of the following potential uses of tumor markers involves assessing treatment outcomes?

Detecting the recurrence of cancer Signup and view all the answers

What is a significant limitation of most tumor markers when used for cancer screening?

They can be present in normal and benign tissues. Signup and view all the answers

In cancer diagnostics, what does a higher plasma level of a tumor marker generally indicate?

Higher tumor burden Signup and view all the answers

How can the serum level of a tumor marker serve as a prognostic indicator?

It reflects tumor burden and predicts patient survival. Signup and view all the answers

What may the rate of decrease in a tumor marker's level after treatment indicate?

The degree of success of the treatment Signup and view all the answers

Which of the following is true regarding the specificity of tumor markers?

Most markers are found in different tumors of the same tissue type. Signup and view all the answers

What clinical utility does quantifying tumor markers provide?

It aids in the clinical staging of cancer. Signup and view all the answers

What does an increase in alkaline phosphatase (ALP) usually indicate?

Primary liver cancer or metastasis in bone or liver Signup and view all the answers

Which enzyme has largely replaced prostatic acid phosphatase (PAP) in clinical use for prostate cancer?

Prostate Specific Antigen Signup and view all the answers

What is the significance of the ratio between free and total prostate specific antigen (PSA)?

It reliably differentiates between prostatic cancer and benign prostatic hyperplasia Signup and view all the answers

What protocols are recommended for accurate cancer diagnosis when using PSA testing?

PSA testing, followed by DRE and TRUS Signup and view all the answers

How often should the PSA level fall below the detection limit after treatment monitoring?

Within 2-3 weeks Signup and view all the answers

What are potential causes of increased PSA levels in serum that are not cancer-related?

Benign prostatic hyperplasia and urinary bladder catheterization Signup and view all the answers

Which condition can potentially elevate prostatic acid phosphatase (PAP) levels despite having a benign nature?

Hyperparathyroidism Signup and view all the answers

What is a primary use of serum PSA levels in prostate cancer management?

Monitoring treatment effectiveness Signup and view all the answers

What is the primary utility of AFP and hCG in relation to germ cell tumors?

Classifying and staging the tumors Signup and view all the answers

Which of the following cancers is not typically monitored using CEA levels?

Thyroid carcinoma Signup and view all the answers

What does an elevated CA 15-3 level indicate?

Breast carcinoma and other cancers Signup and view all the answers

Why should CEA not be used as a screening tool?

Some tumors do not produce CEA. Signup and view all the answers

What types of cancer are indicated by CA 125 levels?

Ovarian and endometrial carcinoma Signup and view all the answers

How accurate is CA 125 for detecting recurrence of ovarian cancer?

Only 75% accurate Signup and view all the answers

In patients with ovarian masses, what indication does a CA 125 level of less than 65 kU/L provide?

Greater 5-year survival rate Signup and view all the answers

What are carbohydrate markers primarily associated with?

Antigens on tumor cell surfaces Signup and view all the answers

Which cancer types are associated with elevated levels of CA 19-9?

Pancreatic and colorectal cancer Signup and view all the answers

What is the role of β2-microglobulin as a protein marker?

Indicator of chronic inflammation and viral hepatitis Signup and view all the answers

Which condition can be identified by monitoring CA 19-9 levels?

Colorectal cancer monitoring Signup and view all the answers

What does a positive estrogen receptor indicate in breast cancer treatment?

Response to hormonal therapy Signup and view all the answers

Ferritin is a marker for which of the following cancers?

Hodgkin lymphoma Signup and view all the answers

What is the significance of Bence-Jones protein in medical diagnosis?

Monoclonal immunoglobulin light chain in urine Signup and view all the answers

In patients with negative estrogen and progesterone receptors, what is the likely treatment approach?

Opt for chemotherapy or other therapies Signup and view all the answers

Which protein markers are among the most reliable for cancer diagnosis?

β2-microglobulin, ferritin, and immunoglobulin Signup and view all the answers

What percentage of patients with estrogen receptor (+) tumors typically respond to hormonal therapy?

60% Signup and view all the answers

Which type of receptor testing is considered useful as an adjunct to estrogen receptor testing?

Progesterone receptor testing Signup and view all the answers

What is the role of the C-erbB2 (HER-2 Neu) receptor in relation to epidermal growth factor (EGF)?

It serves as a co-receptor in EGF action. Signup and view all the answers

Which class of genes is responsible for the normal regulation of cell growth and differentiation?

Protooncogenes Signup and view all the answers

Mutations in which of the following genes are specifically correlated with an inherited predisposition to breast and ovarian cancer?

BRCA1 and BRCA2 Signup and view all the answers

What effect do alterations in tumor suppressor genes have on tumor development?

They may lead to tumor development. Signup and view all the answers

Which of the following is NOT a type of gene implicated in the development of cancer?

Hormonal receptor genes Signup and view all the answers

Which of these mutations are correlated with acute myeloid leukemia and neuroblastoma?

K-ras and N-ras Signup and view all the answers

Study Notes

Cancer & Tumor Markers

Tumor markers are biochemical substances (hormones, enzymes, proteins) produced by cancer cells or the body's response to cancer.
Symptoms of cancer vary depending on the type but general symptoms include fatigue, weight loss, pain, skin changes, unusual bleeding, persistent cough, and fever.
Treatment options include chemotherapy, radiation, and surgery.
Benign tumors are non-cancerous, while malignant tumors are cancerous and can spread to other tissues and organs.

Types of Cancer

Common cancer types (according to the National Cancer Institute) include bladder, lung, breast, melanoma, endometrial, kidney cancer, leukemia, lymphoma, pancreatic, prostate, colon and rectal cancers.
A diagram shows an example of primary cancers and areas they might metastasize (spread) to, including the brain, lungs, skin, and pancreas.
The most common cancers in men include prostate, lung, and colorectal cancer.
- For women: breast, lung, and colorectal cancer
- For children: leukemia, brain tumors, and lymphoma

Types of Cancers - Classification

Carcinoma: Starts in the skin or tissues lining internal organs (e.g., skin, lung, colon, pancreas). Subtypes include adenocarcinoma, basal cell carcinoma, squamous cell carcinoma, and transitional cell carcinoma.
Sarcoma: Begins in bone, cartilage, or other connective tissue. This includes bone sarcomas and soft tissue sarcomas.
Leukemia: Starts in blood-forming tissue, causing abnormal blood cells to enter the bloodstream. Ages of onset include 0-5, 14-18, 19-40, and 60+. Subtypes include lymphoblastic leukemia and T-cell leukemia.
Lymphoma & Myeloma: Starts in white blood cells, affecting lymph nodes. The tissue sites it affects can include the stomach, brain, and intestines. Subtypes include B-cell lymphocytes and T-cell lymphocytes. -Myeloma develops in plasma cells, is a blood cancer, and can damage bones, kidneys, and the red blood cell count.
Central Nervous System Cancers: Start in brain tissue and spinal cord. The brain controls the body by sending electrical signals along nerve fibers, and the brain and spinal cord form the central nervous system.

Normal vs. Cancerous Cells

Normal cells divide and go through apoptosis (cell death) when damaged. Cancer cells multiply constantly, have an altered nucleus structure, irregular shapes, and lack defined boundaries in groups.

Role of Cell Division in Cancer

Benign tumors do not spread
Malignant tumors invade surrounding tissues.
Cancer cells may break off and form new tumors (metastasis).

Spread of Cancer

Primary cancer starts at a site in the body. It may spread (metastasize) to other parts of the body.
Secondary cancers form from the spread of primary cancer.

Spread to Other Areas of Body

Cancer cells can spread through blood vessels (capillaries) and the lymphatic system.
Circulation tumor cells may get lodged in small blood vessels, move through capillary walls, and form new tumors in other organs.

###Properties of Cancer Cells

Cancer cells display uncontrolled cell division leading to tumor formation.
They have decreased cell adhesion.
They show diverse genetic alterations.
Cancer cells lack differentiation to normal cell characteristics.
They lose the ability to communicate with other cells.
They lose sensitivity, adhesion molecules.

Tumor Markers- Properties

Tumor markers should be present in or produced by the tumor itself.
Tumor markers should not be present in healthy tissues.
Tumor marker levels need to be minimal in healthy subjects and benign conditions.
Tumor markers should be specific to a tissue and have different immunological properties from those produced elsewhere in the body.
Plasma marker levels are proportional to the tumor's size and activity.
Tumor marker half-lives should not be excessively prolonged.
Tumor markers should be detectable even in small tumors.
Tumor markers are helpful in predicting recurrence.

Classification of Tumor Markers

They are classified by molecular type. This includes enzymes/isoenzymes, hormones, oncofetal antigens, carbohydrate epitopes recognized by monoclonal antibodies, and receptors.
Specific examples of tumor markers by type are provided for some common types of cancer.

Potential Uses of Tumor Markers

Screening the general population.
Diagnosing symptomatic patients.
Clinically staging cancer.
Estimating tumor volume.
Prognostic indicator of disease progression.
Evaluating the success of treatment. detecting recurrence of cancer.
Monitoring response to therapy
Radioimmunolocalization of tumor masses.

Tumor Marker Considerations

Most tumor markers are not specific for singular tumors, but are found in multiple tumor types.
Tumor markers are typically present in higher quantities in cancer patients' blood versus healthy subjects or those with benign diseases.
Some tumor markers are proportionate to tumor size, while others reflect activity.
The clinical staging of cancer can be assisted by tumor marker quantification.
Serum levels reflect tumor burden and prognostic indicators of disease progression and survival.
The response to therapies are often indicated by drops in tumor markers. Recurrence is often indicated by an increase in marker.

Specific Tumor Markers — Examples

Enzymes: Alkaline phosphatase (ALP) and Prostatic acid phosphatase (PAP). Increased levels associated with liver cancer, bone/liver metastatic cancer or other malignancies like ovarian, lung cancers. PAP is used to stage prostate cancer & monitor treatment.
PSA: Prostate-specific antigen. Used for prostate cancer—it's highly specific to it during early cancer.
Hormones: Calcitonin. High levels are usually associated with medullary thyroid cancer and can correlate with tumor volume and metastasis.
Oncofetal Antigens: a-fetoprotein (AFP) and carcinoembryonic antigen (CEA). AFP is useful for screening and diagnosing hepatocellular carcinoma, pregnancy and chronic liver disease. CEA is a marker for colorectal, lung, and breast cancers.
Carbohydrate Markers: CA 15-3, CA 125, CA 19-9. CA 15-3 is correlated with breast cancer. CA 125 is linked to ovarian/endometrial cancers and detecting residual disease. CA 19-9 is a marker for pancreatic and colorectal cancers.
Protein Markers: β2-microglobulin, ferritin, thyroglobulin, Immunoglobulins (including monoclonal paraproteins and Bence-Jones protein). β2-microglobulin links to multiple myeloma, Hodgkin lymphoma. Ferritin is a marker for Hodgkin lymphoma, leukemia, liver, lung, and breast cancers. Thyroglobulin helps detect differentiated thyroid cancer. Immunoglobulins/Bence-Jones are markers for multiple myeloma.
Receptor Markers: Estrogen and progesterone receptors in breast cancer are used for hormonal therapies. Measuring cytoplasmic receptors are crucial.

Genetic Changes

Proto-oncogenes, tumor suppressor genes, apoptosis-related genes, and DNA repair genes are related to cancer development.
These genetic changes are linked to chronic myeloid leukemia, neuroblastoma, acute myeloid leukemia ,breast and ovarian cancers, and colorectal cancers, and other types.
Genes are implicated in normal cell growth and differentiation, regulating apoptosis (programmed cell death), and DNA repair.

Chromosomal Translocations

Translocations involve chromosomes exchanging segments. One example is the c-myc gene translocation in Burkitt's lymphoma. Also, translocations in chromosomes 9 and 22 are associated with chronic myeloid leukemia.

Conclusion

Tumor markers assist in cancer diagnosis, staging, prognosis, and monitoring treatment success.
However, because tumor markers are not always specific to a single tumor type, and some conditions other than cancer can produce these markers, additional testing is often necessary to clarify diagnostic and staging findings.

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Description

This quiz explores the essential characteristics and significance of tumor markers in cancer diagnostics and management. Questions cover their classification, uses, and limitations, providing a comprehensive understanding of their role in screening and treatment outcomes. Test your knowledge and see how well you understand tumor markers!