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Wednesday, September 1, 2021

Cancer Tumour Markers ( Tumour Markers): Alpha-fetoprotein (AFP), CA-125, CA 19-9... By Nurses Note

Cancer Tumour Markers ( Tumour Markers)


Tumour Markers are used in many different aspects of cancer care. They can be used in screening for early detection of cancer, as a measure of initial tumour burden, as a measure of response to anticancer therapy, or in early detection of recurrent cancer (biochemical evidence of recurrence).

Test Explanation

Tumour Markers are produced by cancer cells or by other cells of the body in response to cancer. Most TMs are made by normal cells as well as by cancer cells; however, they are over-produced by cancers. These substances can be found in the blood, urine, stool, tumour tissue, or other tissues or bodily fluids. Most TMs are proteins. However, changes in tumour cell RNA and DNA are also used as Tumor markers. Many different tumour markers have been characterized. Some are associated with only one type of cancer, whereas others are associated with two or more cancer types. Sometimes, noncancerous conditions can cause elevated tumour markers though usually less elevated than cancer.

Tumour markers are generally not used for cancer screenings because they are not sensitive or specific enough. Neither are they used, alone, to diagnose cancers. Measurement of tumour markers is usually used in combination with other tests, such as biopsies, to diagnose cancer. PSA, CA-125 and a few other tumour markers are being used very carefully in screening, but, alone, the cost-effectiveness is questionable.

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Serial measurements are often more useful than an isolated measurement; serial measurements show whether the tumour markers are increasing, decreasing or static. Tumour markers levels may be measured before treatment to help doctors plan the appropriate therapy. In some types of Cancer, the level of tumour marker reflects the stage of the disease and patient prognosis). Pretreatment tumour markers measurement can be used to establish a baseline against which posttreatment tumour Markers can be compared in order to determine the effectiveness of therapy. A decrease in the level of a tumour markers or a return to normal level may indicate that the cancer is responding to treatment, whereas no change or an increase may indicate that the cancer is not responding.

Tumour markers may also be measured during cancer follow-up evaluations to check for recurrent disease. There are many Tumor Markers presently being used in cancer care. The most commonly used markers list are below.

Tumour Markers and Their Associated Cancer

  1. ALK gene: Non-small cell lung cancer Lymphoma
  2. Alpha-fetoprotein (AFP): Liver, Germ cell tumours.
  3. BCR-ABL fusion gene (Philadelphia chromosome ): Chronic myeloid leukaemia, Acute lymphoblastic leukaemia, acute myelogenous leukaemia.
  4. Beta 2 microglobulin: Liver, Multiple Myeloma, Lymphoma.
  5. BRAF V600 mutations: Cutaneous melanoma, Colorectal.
  6. C-kit/CD117: Gastrointestinal stromal tumor, Mucosal melanoma.
  7. CA-125: Ovary.
  8. CA 15-3/CA27.28: Breast.
  9. CA 19-9: Pancreas, Biliary, Stomach.
  10. Calcitonin: Medullary thyroid carcinoma.
  11. Carcinoembryonic antigen (CEA): Colon, Other Gastrointestinal tumors, Breast.
  12. CD20: Non-Hodgkin lymphoma.
  13. Chromogranin A (CgA): Neuroendocrine.
  14. Chromosomes 3, 17, and 9p21: Bladder.
  15. Cytokeratin fragment 21-1: Lung.
  16. Fibrin/fibrinogen degradation products: Bladder.
  17. HE4: Ovary.
  18. Human chorionic gonadotropin (beta-hCG): Choriocarcinoma, Germ cell tumours.
  19. Immunoglobulin monoclonal protein (protein M): Multiple myeloma, Waldenstrom macroglobulinemia.
  20. Inhibin A: Germ cell tumours of ovary.
  21. KRAS: Colorectal, Non-small cell lung cancer.
  22. Lactate dehydrogenase (LDH): Germ cell tumours. Leukaemia, Melanoma, Brain.
  23. Neuron-specific enolase(NSE): Small cell lung cancer, Neuroblastoma.
  24. Nuclear matrix protein 22: Bladder.
  25. Plasminogen activator inhibitor (PAI-1): Breast.
  26. Programmed death ligand 1 (PD-L1): Non-small cell lung cancer.
  27. Prostate-specific antigen (PSA): Prostate.
  28. Squamous cell carcinoma (SCC) antigen: Squamous cell carcinoma of the cervix, oral cavity, oesophagus, lung, anal canal.
  29. Thyroglobulin: Thyroid.
  30. Urokinase plasminogen activator (uPA): Breast.

Interfering Factors

  1. Other benign and malignant diseases may be associated with elevated levels.

Procedure and Patient Care

  1. Fasting: no
  2. Blood tube commonly used: varies by test and laboratory.
  3. The blood sample may be sent to central diagnostic laboratory. The result may not be available for 7 to 10 days.

Test Results and Clinical Significance

Increased levels

  1. Cancer
  2. Metastatic cancer
  3. Recurrent cancer
  4. Benign disease

Reference Mosby Manual Diagnostic and Laboratory tests

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