Definition of Tumor marker

Tumor marker: Tumor markers are substances that can be detected in higher-thannormal amounts in the blood, urine, or body tissues of some patients with certain types of cancer. A tumor marker may be made by a tumor itself or by the body in response to the tumor. Such a substance serves to "mark" the tumor; it is a "tumor marker." Tumor marker tests are not used alone to detect and diagnose cancer because most tumor markers can be elevated in patients who don t have a tumor; because no tumor marker is entirely specific to a particular type of cancer; and because not every cancer patient has an elevated tumor marker level, especially in the early stages of cancer, when tumor marker levels are usually still normal. Although tumor markers are typically imperfect as screening tests to detect occult !hidden" cancers, once a particular tumor has been found with a marker, the marker may be a marvel as a means of monitoring the success !or failure" of treatment. The tumor marker level may also reflect the e#tent !the stage" of the disease, indicate how $uickly the cancer is likely to progress and so help determine the prognosis !outlook". %#amples of tumor markers include alpha-fetoprotein !A&'", carcinoembryonic antigen !(%A", human chorionic gonadotropin !)(*", lactate dehydrogenase !+,)", and neuron-specific enolase !-S%".

Tumor marker
From Wikipedia, the free encyclopedia
.ump to/ navigation, search A tumor marker is a substance found in the blood, urine, or body tissues that can be elevated in cancer, among other tissue types. There are many different tumor markers, each indicative of a particular disease process, and they are used in oncology to help detect the presence of cancer. An elevated level of a tumor marker can indicate cancer; however, there can also be other causes of the elevation.

Contents
0hide1

2 ,escription 3 (lassification o 3.2 (ancer-specific markers o 3.3 Tissue-specific markers 4 Application and 5nterpretation 6 See also 7 8eferences

9 %#ternal links

[edit] Description
Tumor markers can be produced directly by the tumor or by non-tumor cells as a response to the presence of a tumor. :oepke021 outlines a hierarchy of clinical laboratory tests, from least to most informative. As used in oncology, they are as follows/

Screening for common cancers on a population basis

%#ample/ elevated prostate specific antigen suggests prostate cancer.

Monitoring of cancer survivors after treatment

%#ample/ elevated A&' in a child previously treated for teratoma suggests relapse with endodermal sinus tumor.

Diagnosis of specific tumor types, particularly in certain brain tumors and other instances where biopsy is not feasible.

The term tumor antigen is sometimes interchangeably used for tumor marker.

[edit] Classification
Tumor markers can be classified in two groups/ (ancer-specific markers and tissuespecific markers.

[edit] Cancer-specific markers

(ancer-specific markers are related to the presence of certain cancerous tissue. ;ecause there is a large overlap between the many different tumor tissue types and the markers produced these markers might not be specific in making a diagnosis. They can, however, be useful in the follow-up of treated patients to describe progress of the disease or response to treatment. A few e#amples of these markers are (%A, (A2<-<, (A237. An e#ample of a cancer-specific marker, (%A, or carcinoembryonic antigen, is a bloodborne protein, first noted to be produced by tumors of the gastrointestinal system. &urther investigation showed that it was produced by the occasional lung and breast cancer case, meaning that an elevated level does not necessarily mean a bowel cancer. )owever, in a patient with a history of a treated bowel cancer, a rising (%A level can be an early sign of recurring bowel cancer. This usually occurs before the site of return can be identified on imaging or e#amination and so many oncologists $uestion the wisdom of doing a blood test for (%A when the end result is bad news that alarms the patient. -evertheless, a

se$uence of steady low (%A readings can provide much needed reassurance to the postoperative patient. Also, a rising se$uence of (%A readings should alert the physician to the need for diagnostic tests such as '%T scans.

[edit] Tissue-specific markers

Tissue-specific markers are related to specific tissues which have developed cancer. *enerally speaking, these substances are not specifically related to the tumor, and may be present at elevated levels when no cancer is present. ;ut unlike the previous group, elevated levels point to a specific tissue being at fault. %#amples include 'SA, beta-)(* - !)uman chorionic gonadotropin", A&' - !Alpha-fetoprotein", A&'-+4 - !a lectinreactive A&'" and Thyroglobulin. &or e#ample, if a man has an elevated 'SA, a search for prostate cancer will be undertaken. 5f an individual has an elevated level of beta)(*, A&' or A&'-+4=, a search for a testicular or liver cancer, respectively, will be made. PSA !'rostate specific antigen" is produced by the normal prostate. 5t is a protein en>yme called a serine protease that usually acts as an anticoagulant to keep semen li$uid. ?nly small amounts leak into the circulation in normal circumstances. %nlarged prostates leak more substantial amounts, and cancerous prostates also leak substantial amounts. An accurate way to tell if an elevated 'SA level results from cancer is to biopsy the prostate. -hCG/ %levated levels cannot prove the presence of a tumor, and low levels do not rule it out !an e#ception is in males who do not naturally produce @-h(*". -evertheless, elevated @h(* levels fall after successful treatment !e.g. surgical intervention or chemotherapy", and a recurrence can often be detected by the finding of rising levels.

[edit] Application and Interpretation

The hook effect !also known as hi h dose hook effect" is an artifact of tumor marker immunoassay kits, that causes the reported $uantity of tumor marker to be incorrectly low when the $uantity is high. An undetected hook effect may cause delayed recognition of a tumor.031 The hook effect can be detected by analy>ing serial dilutions. Absent hook effect, reported $uantities of tumor marker in a serial dilution should be proportional to the dilution. 5f repeated measurements of tumor marker are needed, some clinical testing laboratories provide a special reporting mechanism, a serial monitor, that links test results and other data pertaining to the person being tested. This re$uires a uni$ue identifier for the person. 5n the Anited States commonly a Social Security number is used for this. ?ne important function of this mechanism is to ensure that each test is performed using the same assay kit. &or e#ample, for A&' many different commercial assay kits, based on different technologies, are available. A&' measurements obtained using different assay kits are not compara!le unless special calculations are performed.

5nterlaboratory proficiency testing for tumor marker tests, and for clinical tests more generally, is an emerging field.0215n the Anited States, -ew Bork state is prominent in advocating such research.041

[edit] See also

Tumor antigen

[edit] "eferences
2. C a b 'ubDed free full te#t 3. # +eboeuf 8, +anglois D&, Dartin D, Ahnadi (%, &ink *, !3EE9". "")ook effect" in calcitonin immunoradiometric assay in patients with metastatic medullary thyroid carcinoma/ case report and review of the literature". J. Clin. Endocrinol. Metab. 91 (2): 3614. doi:2E.232EFGc.3EE7-263<. 'D5, 293HI394. 4. # 'romoting Safe and %ffective *enetic Testing in the Anited States genome.gov

Tumor Darkers email this page print this page was this page helpful $hat are the%& Tumor markers are substances, usually proteins, that are produced by the body in response to cancer growth or by the cancer tissue itself. Some tumor markers are specific, while others are seen in several cancer types. Dany of the well-known markers are also seen in non-cancerous conditions. (onse$uently, these tumor markers are not diagnostic for cancer. Jhat are they Jhy done There are only a handful of well-established tumor markers that are being Table of routinely used by physicians. Dany other potential markers are still being markers researched. Some marker tests cause great e#citement when they are first +inks discovered but, upon further investigation, prove to be no more useful Sources than markers already in use. The goal is to be able to screen for and diagnose cancer early, when it is the most treatable and before it has had a chance to grow and spread. So far, the only tumor marker to gain wide acceptance as a general screen is the 'rostate Specific Antigen

!'SA" for men. ?ther markers are either not specific enough !too many false positives, leading to e#pensive and unnecessary follow-up testing" or they are not elevated early enough in the disease process. Some people are at a higher risk for particular cancers because they have inherited a genetic mutation. Jhile not considered tumor makers, there are tests that look for these mutations in order to estimate the risk of developing a particular type of cancer. ;8(A2 and ;8(A3 are e#amples of gene mutations related to an inherited risk of breast cancer and ovarian cancer. &or more information, see our overview on genetic testing. Tumor Darkers email this page Jhat are they Jhy done Table of markers +inks Sources print this page was this page helpful $h% are the% done& Tumor markers are not diagnostic in themselves. A definitive diagnosis of cancer is made by looking at biopsy specimens !e.g., of tissue" under a microscope. )owever, tumor markers provide information that can be used to/

Screen. Dost markers are not suited for general screening, but some may be used in those with a strong family history of a particular cancer. 5n the case of genetic markers, they may be used to help predict risk in family members. 'SA testing for prostate cancer is an e#ample. Hel diagnose. 5n a patient that has symptoms, tumor markers may be used to help identify the source of the cancer, such as (A-237 for ovarian cancer, and to help differentiate it from other conditions. 8emember that tumor markers cannot diagnose cancer themselves but aid in this process. Stage. 5f a patient does have cancer, tumor marker elevations can be used to help determine how far the cancer has spread into other tissues and organs. Deter!ine rognosis. Some tumor markers can be used to help doctors determine how aggressive a cancer is likely to be. "#ide $reat!ent. Some tumor markers, such as )er3Fneu, will give doctors information about what treatments their patients may respond to !for instance, breast cancer patients who are )er3Fneu positive are more likely to respond to )erceptin treatment".

Monitor $reat!ent. Tumor markers can be used to monitor the effectiveness of treatment, especially in advanced cancers. 5f the marker level drops, the treatment is working; if it stays elevated, adGustments are needed. The information must be used with care, however. (%A, for instance, is used to monitor colorectal cancer, but not every colorectal cancer patient will have elevated levels of (%A. Deter!ine rec#rrence. (urrently, one of the biggest uses for tumor markers is to monitor for cancer recurrence. 5f a tumor marker is elevated before treatment, low after treatment, and then begins to rise over time, then it is likely that the cancer is returning. !5f it remains elevated after surgery, then chances are that not all of the cancer was removed."

Tumor Darkers Jhat are they Jhy done Table of markers +inks Sources email this page print this page was this page helpful
Common Tumor Markers Currently in Use

Tumor Markers AFP (Alphafeto protein)

Cancers

What else?

When/How sed

Usual Sample

Liver, germ cell Also elevated cancer of ovaries or during pregnancy testes

Help diagnose, Blood monitor treatment, and determine recurrence Blood

B2M (Beta 2 microglo!ulin"

Multiple m#eloma and l#mp$omas

%resent in man# (etermine ot$er conditions, prognosis including Cro$n&s disease and $epatitis' often used to determine cause of renal

failure BTA (Bladder tumor antigen" Bladder )aining acceptance Also elevated in !enign !reast conditions' doctor can use CA *+ , or CA 2-.2/ (t0o different assa#s for same marker" Help diagnose Urine and determine recurrence Stage disease, Blood monitor treatment, and determine recurrence

CA *+ , Breast and ot$ers (Cancer antigen including lung, *+ ," ovarian

CA */ / %ancreatic, Also elevated in (Cancer antigen sometimes colorectal pancreatitis and */ /" and !ile ducts inflammator# !o0el disease CA -2 1 2varian (Cancer antigen -2 1"

Stage disease, Blood monitor treatment, and determine recurrence

3o evidence t$at Help diagnose Blood it is !etter t$an CA *2+ !ut ma# !e useful 0$en com!ined 0it$ it Also elevated 0it$ Help diagnose, Blood endo metriosis, monitor some ot$er treatment, and diseases and determine !enign conditions' recurrence not recommended as a general screen Also elevated in Help diagnose, Blood pernicious anemia monitor and t$#roiditis treatment, and determine recurrence 4levated in ot$er Monitor Blood conditions suc$ as treatment and $epatitis, C2%(, determine colitis, recurrence pancreatitis, and in cigarette smokers )uide Tissue treatment and determine prognosis

CA *2+ (Cancer 2varian antigen *2+"

Calcitonin

T$#roid medullar# carcinoma

C4A (Carcino em!r#onic antigen"

Colorectal, lung, !reast, thyroid, pancreatic,

liver, cervi#, and bladder

4)56 (Her *"

solid tumors, suc$ as 3ot availa!le in of t$e lung (non small ever# la!orator# cell", $ead and neck, colon, pancreas, or !reast Breast

4strogen receptors

7ncreased in (etermine Tissue $ormone prognosis and dependent cancer guide treatment

$C) (Human c$orionic gonadotropin"

Testicular and trop$o!lastic

4levated in pregnanc#, testicular failure

Help diagnose, Blood, monitor urine treatment, and determine recurrence Tissue

Breast

2ncogene t$at is (etermine

Her 28neu

present in multiple prognosis and copies in 29 ,9: guide treatment of invasive !reast cancer Multiple m#eloma and2verproduction of Help diagnose, Blood, ;aldenstrom&s an monitor urine macroglo!ulinemia immunoglo!ulin or treatment, and anti!od#, usuall# determine detected !# recurrence protein electrop$oresis Blood

Monoclonal immunoglo!ulin s

3S4 (3euron 3euro!lastoma, small Ma# !e !etter Monitor specific enolase" cell lung cancer t$an C4A for treatment follo0ing t$is particular kind of lung cancer 3M%22 Bladder 3ot 0idel# used

Help diagnose Urine and determine recurrence

Breast %rogesterone receptors

7ncreased in (etermine Tissue $ormone prognosis and dependent cancer guide treatment

%SA (%rostate specific antigen", total and free

%rostate

4levated in !enign Screen for and Blood prostatic $elp diagnose, $#pertrop$#, monitor prostatitis and treatment, and 0it$ age determine recurrence 3ot 0idel# used, Help diagnose Blood levels increase normall# 0it$ age 3ot 0idel# used Help diagnose Blood an#more, elevated in prostatitis and ot$er conditions Help diagnose Blood

%rostate specific %rostate mem!rane antigen (%SMA" %rostatic acid p$osp$atase (%A%" S *99 TA /9 Metastatic prostate cancer, m#eloma, lung cancer

Metastatic melanoma 3ot 0idel# used

Metastatic melanoma 3ot 0idel# used, Help diagnose Blood !eing studied T$#roid Used after t$#roid (etermine is removed to recurrence evaluate treatment Blood

T$#roglo!ulin