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Questions and Answers
Increased levels of CEA can indicate pancreatic carcinoma.
Increased levels of CEA can indicate pancreatic carcinoma.
True
HCG is primarily used to diagnose lung cancer.
HCG is primarily used to diagnose lung cancer.
False
The production of CEA stops before birth and then increases in adults who smoke heavily.
The production of CEA stops before birth and then increases in adults who smoke heavily.
True
Malignant liver conditions do not include metastatic cancer originating in other organs.
Malignant liver conditions do not include metastatic cancer originating in other organs.
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Germ cell tumors can occur in both the testes and ovaries.
Germ cell tumors can occur in both the testes and ovaries.
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Absolute indications for AFP include liver cirrhosis monitoring.
Absolute indications for AFP include liver cirrhosis monitoring.
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The range of carbohydrate composition in CEA is between 50 - 85% of its molecular mass.
The range of carbohydrate composition in CEA is between 50 - 85% of its molecular mass.
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A CEA level of 5 - 10 times the upper limit of normal is indicative of gastritis.
A CEA level of 5 - 10 times the upper limit of normal is indicative of gastritis.
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Absolute indications for HCG include conditions like choriocarcinoma.
Absolute indications for HCG include conditions like choriocarcinoma.
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Breast carcinoma can show a distribution of CEA levels greater than 10 ng/ml in 23% of patients.
Breast carcinoma can show a distribution of CEA levels greater than 10 ng/ml in 23% of patients.
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CA 19-9 is primarily used for diagnosing ovarian cancer.
CA 19-9 is primarily used for diagnosing ovarian cancer.
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CA-125 has a cut-off value of 35 U/ml.
CA-125 has a cut-off value of 35 U/ml.
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CA 15-3 is primarily used for monitoring colorectal cancer.
CA 15-3 is primarily used for monitoring colorectal cancer.
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PSA levels can be elevated due to benign prostatic hyperplasia.
PSA levels can be elevated due to benign prostatic hyperplasia.
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NSE is primarily used for monitoring breast cancer treatment outcomes.
NSE is primarily used for monitoring breast cancer treatment outcomes.
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CA 125 was introduced in 1983 by Bast specifically for pancreatic cancer.
CA 125 was introduced in 1983 by Bast specifically for pancreatic cancer.
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The major diagnostic relevance of CA 19-9 is in colorectal cancer.
The major diagnostic relevance of CA 19-9 is in colorectal cancer.
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An asymptomatic man over 50 years old should undergo transrectal ultrasound if PSA levels are elevated.
An asymptomatic man over 50 years old should undergo transrectal ultrasound if PSA levels are elevated.
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Colorectal cancer can also be monitored using CA-125 as a second-line marker.
Colorectal cancer can also be monitored using CA-125 as a second-line marker.
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The major diagnostic relevance for CA 125 lies solely in evaluating the success of treatment.
The major diagnostic relevance for CA 125 lies solely in evaluating the success of treatment.
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Tumor markers can exclusively diagnose cancer on their own.
Tumor markers can exclusively diagnose cancer on their own.
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Alpha-fetoprotein (AFP) is primarily used for monitoring leukemia.
Alpha-fetoprotein (AFP) is primarily used for monitoring leukemia.
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Hormones such as ACTH can serve as tumor markers.
Hormones such as ACTH can serve as tumor markers.
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CA-125 is a tumor marker associated with monitoring ovarian cancer.
CA-125 is a tumor marker associated with monitoring ovarian cancer.
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An ideal tumor marker should vary significantly in healthy individuals compared to cancer patients.
An ideal tumor marker should vary significantly in healthy individuals compared to cancer patients.
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Creatin kinase is classified as a carbohydrate antigen tumor marker.
Creatin kinase is classified as a carbohydrate antigen tumor marker.
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Neuron-specific enolase (NSE) is one of the enzymes that can act as a tumor marker.
Neuron-specific enolase (NSE) is one of the enzymes that can act as a tumor marker.
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Tumor markers are effective for screening asymptomatic individuals due to their high specificity.
Tumor markers are effective for screening asymptomatic individuals due to their high specificity.
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Prostate specific antigen (PSA) is used to monitor bladder cancer recurrences.
Prostate specific antigen (PSA) is used to monitor bladder cancer recurrences.
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A tumor marker with 100% sensitivity and specificity has been found.
A tumor marker with 100% sensitivity and specificity has been found.
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Study Notes
Tumor Markers
- Tumor markers are substances produced directly by tumor cells or induced by tumor cells in non-tumorous cells.
Classification of Tumor Markers
-
Onkofetal proteins:
- Carcinoembryonic antigen (CEA)
- Alpha-fetoprotein (AFP)
- Human chorionic gonadotropin (hCG)
-
Carbohydrate antigen:
- CA-125
- CA-19-9
- CA-15-3 and CA 27-29
- CA-72-4
-
Enzymes:
- Creatin kinase
- Lactat dehydrogenase
- Prostate acid phosphatase
- Prostate-specific antigen (PSA)
- Neuron-specific enolasa (NSE)
- Amylase
-
Hormones and hormone receptors:
- ACTH and other endocrine hormones
- Breast estrogen and progesterone receptors
-
Proteins as tumor markers:
- B2-microglobulin
- C-peptide
- Ferritin
- Thyreoglobulin
-
Other markers:
- Cytokeratin-19 (CYFRA 21-1)
- Tissue polypeptide-antigen (TPA)
- Tissue polypeptide-specific (TPS) antigen
- Squamous cell carcinoma (SCC) antigen
Ideal Tumor Marker Criteria
- Specific to the tumor
- Level changes in response to tumor size
- Abnormal levels present in micrometastases
- Stable level independent of tumor size changes
- Low levels in healthy individuals
- Predicts recurrence before clinical detection
- Cost-effective testing
Indication of Tumor Markers
- Early detection of malignant tumors in high-risk groups
- Primary diagnosis
- Prognostic utility
- Therapy monitoring
- Early detection of tumor recurrence
Common Tumor Markers
- CEA: Monitor colorectal, breast, and lung cancer
- CA-125: Ovarian cancer monitoring
- CA-15-3: Monitor breast cancer recurrences
- AFP: Germ cell tumors and liver cancer
- Total PSA: Screen and monitor prostate cancer
- Free PSA: Distinguish prostate cancer from benign prostatic hyperplasia (BPH)
- HCG: Germ cell and trophoblastic tumors
- Hormone receptors: Breast cancer therapy
- NMP 22: Monitor bladder cancer recurrences
Tumor Markers and Screening Asymptomatic Individuals
- Tumor markers are not suitable for screening asymptomatic individuals due to low organ and tumor specificity.
Alpha-fetoprotein (AFP)
- Widely used biochemical blood test for liver cancer (hepatocellular carcinoma, HCC)
- Normally produced by immature liver cells during fetal development.
AFP (Malignant Conditions)
- Liver cancer (hepatocellular carcinoma)
- Germ cell tumors (cancer of the testes and ovaries)
- Metastatic cancer to the liver
AFP (Non-Malignant Conditions)
- Pregnancy
- Cirrhosis
- Hepatitis
AFP (Absolute Indication)
- Suspected hepatocellular carcinoma
- Germ cell tumors (testes, ovaries)
- Follow-up of patients after treatment for germ cell tumors or primary liver cancer
CEA (Carcinoembryonic Antigen)
- Glycoprotein antigen
- Normal serum value: <2.5ng/mL (nonsmokers), <5ng/mL (smokers)
- Elevated in colorectal, breast, pancreatic, gastric, and lung cancers
- Benign conditions include cigarette smoking, peptic ulcer disease, inflammatory bowel disease, cirrhosis, and biliary obstruction.
CEA (Clinical Uses)
- Pre-operative: Values >7.5 ng/mL associate with poor prognosis
- Post-operative: Measures tumor resection completeness
- Monitoring tumor recurrence: Rising trend predicts recurrence
- Monitoring tumor regression in metastatic disease: Serial values show regression or progression
CEA (Prognostic value)
- Overall survival is decreased significantly when pre-operative CEA is >5 ng/mL (except in advanced disease).
- Sensitivity increases with advancing tumor stage (50% in N+ patients, 75% in M+ patients).
CEA (Molecular Information)
- Described by Gold and Freedman in 1965
- Glycoprotein with carbohydrate composition (50-85% of molecular mass)
- Produced during fetal development; production stops before birth.
- CEA levels are raised in heavy smokers.
- CEA levels 5-10 times upper limits of normal suggest colon cancer
- Used to screen for colon cancer
Increased Levels of CEA
- Colorectal carcinoma
- Pancreatic carcinoma
- Lung carcinoma
- Breast carcinoma
CEA Distribution in Patients with Malignant Disease
- Data presented in a table format showing percentage distributions of CEA levels in various cancers
HCG (Human Chorionic Gonadotropin)
- Important in initial diagnosis, following treatment response, determining cancer prognosis, and early detection of recurrence for certain cancers.
- Serum HCG ratio of >1:60 suggests cerebral metastases.
- Elevated HCG levels in woman after pregnancy may indicate cancer.
CA 19-9
- Intracellular adhesion molecule
- Normal serum value: <37 U/mL
- Malignancies include pancreatic cancer, colorectal cancer, and biliary tract cancer
- Benign conditions include pancreatitis and benign biliary tract diseases
- Sensitivity and specificity of 80-90% (differentiating malignant from benign pancreatic disease).
- Valuable tumor marker for following patients with pancreatic cancer.
- Less effective for colorectal cancer.
CA 125
- Glycoprotein usually expressed in coelomic epithelium during fetal development
- Normal serum value: <35 U/mL, t1/2: 4-5 days
- Malignancies include advanced epithelial ovarian cancer, in 90% of patients with advanced epithelial ovarian cancers.
- Diagnosis of ovarian cancer, evaluating treatment success, and disease course.
- Used as a second-line marker for pancreatic cancer after CA19-9.
CA 15-3
- Useful for monitoring disease course in patients with metastatic breast cancer
- Elevated in breast cancer, pancreas, gastric, ovarian, and lung and liver cancers
- Benign conditions include benign breast conditions, chronic hepatitis, cirrhosis, sarcoidosis, TB, and SLE
- Most sensitive in all stages of breast cancers.
NSE (Neuron-Specific Enolase)
- Useful to monitor treatment outcome and disease progression in patients with neuroendocrine tumors like small cell lung cancer and neuroblastoma.
PSA (Prostate-Specific Antigen)
- Protein produced by prostate gland cells
- Present in small quantities in normal men and can be elevated in prostate cancer and other prostate disorders like prostatitis and benign prostatic hyperplasia (BPH).
- Screening for asymptomatic men >50 years of age.
- Use in conjunction with digital rectal examination and transrectal ultrasound/biopsy.
PSA (Prognostic Value)
- Elevated pre-operative PSA associated with poor prognosis.
- Post-operative PSA assesses tumor resection completeness.
- Serial PSA values can monitor tumor recurrence or regression in metastatic disease.
PSA (Common use)
- Screening asymptomatic men over 50 for prostate cancer. Markers are useful in conjunction with other diagnostic tools
- Highly sensitive marker for prostate cancer but less specific.
- Used in assessing response to therapy and following up patients with prostate cancer
PSA (Other Markers)
- Prostatic acid phosphatase (PAP) -- Used before PSA test and less sensitive
- Prostate-specific membrane antigen (PSMA) -- Sensitive marker, but not better than PSA and research ongoing
Case Studies
- Several case studies (Case 1- Case 4) demonstrate different scenarios and the markers suggested for diagnosis and prognosis in patients with different suspected cancer types. Specific tumor markers for each case are noted.
Conclusions
- Tumor markers have improved diagnostics and cancer management.
- Markers play a crucial role in staging cancers, screening, and prognosis e.g. testicular, prostate, colorectal, and others
- Further research is needed to refine marker use for better cancer patient management.
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Description
Explore the diverse classifications and examples of tumor markers that are produced by tumor cells. This quiz covers onkofetal proteins, carbohydrate antigens, enzymes, hormones, and other markers, providing insight into their significance in oncology. Test your knowledge on essential tumor markers and their clinical relevance.
