1 / 30

TUMOR MARKERS

TUMOR MARKERS. Dr. Ismet M. Nur Sp.PA (K), MM. Dept. of Pathology Anatomy UNPAD / Hasan Sadikin Hospital Bandung. Tumor markers are :. Biochemical indicators of the presence of a tumor

telyn
Download Presentation

TUMOR MARKERS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TUMOR MARKERS Dr. Ismet M. NurSp.PA (K), MM. Dept. of Pathology Anatomy UNPAD/ HasanSadikin Hospital Bandung

  2. Tumor markers are : • Biochemical indicators of the presence of a tumor • Substances that can often be detected in higher than normal amount in the blood, urine or body tissues of some patients with certain types of cancer • Include cell surface antigens, cytoplasmic proteins, enzymes and hormones

  3. Tumor markers • Produced either by the tumor itself or by the body in response to the presence of cancer. • The utility in clinical medicine is to support the diagnosis, determining in the response to therapy, follow up , and prognosis

  4. How to detect ? • The tissue samples are available from : • - exision or biopsy • - needle biopsy • - cytologic smears Diagnosis of cancer

  5. Methods Immunohistochemistry • Categorization of undifferentiated malignant tumors - keratin for carcinoma ( epithelial origin) - desmin for neoplasm of muscle cell origin • Categorization of leukemia and lymphoma • Determination of site of origin of metastatic cancer

  6. Immuno… • Detection of molecules that have prognostic or therapeutic significance - breast cancer : ER, PR, c-erbB2, p53 BRCA1/ BRCA2 - ovarian cancer / endometrial cancer : ER, PR, c-erbB2, BRCA1/ BRCA2

  7. Methods Molecular Diagnosis by • Cytogenetic analysis • Polymerase Chain Reaction (PCR) • Fluorescence Insitu Hybridization (FISH) • Flow Cytometry

  8. The techniques can be applied for • Diagnosis of malignant neoplasm • Prognosis of malignant neoplasm • Detection of minimal residual disease • Diagnosis of hereditary predisposition to cancer

  9. Selected tumor markers

  10. Incidence of breast cancer : • Rare before age 20, rises steadily around the age of menopause • In USA and Canada 1 in 8 women will develop breast cancer. • In Indonesia , second cause of mortality in women after cervix cancer

  11. Risk factors • Maternal relative with breast cancer • BRCA1 and BRCA2 genes. • Longer reproductive span. • Obesity • Nulliparity • Later age at first pregnancy. • Atypical epithelial hyperplasia • Previous breast ca.

  12. Can Breast Cancer Be Found Early ? • In USA screening mammogram every year for women aged 40 and older. • Between aged 20-39 , clinical breast examination by a health professional every 3 years. • Women aged 20 or older BSE every month

  13. How Is Breast Cancer Diagnosed? • Signs and Symptoms • Medical History and Physical Examination • Imaging Test for Breast Disease Diagnosis • Nipple Discharge Examination • Biopsy

  14. Laboratory Testing of Breast Cancer Biopsy Samples • Types of breast cancer • Grades of breast cancer • Prognostic factors immunohistochemistry

  15. IMMUNOHISTOCHEMISTRY • immunohistochemistry is a staining technique for identifying cellular or tissue constituents (antigens) by using spesific antibody.

  16. IHC for Breast Cancer • Steroid Hormone Receptors • HER-2/ neu / c-erbB-2 • p53 • bcl-2 • nm23H1 • Ki-67 /MIB • MUC1

  17. Steroid Hormone ReceptorsEstrogen Receptor/Progesteron ReceptorER/PR • Predict the response rate to endocrine therapy • Positive hormone receptor status is a favorable prognosis.

  18. The predictive power of combined ER/PR phenotypes in patients with advanced/metastatic breast cancer receiving endocrine therapy (American Univ of Beirut) :Phenotype Incidence Response rateER+/PR+ 58% 77%ER+/PR- 23% 27%ER-/PR+ 4% 46%ER-/PR- 15% 11%

  19. IHC staining of ER :

  20. Oncogene : c-ErbB-2/neu/HER-2 • neu/HER-2 oncogene encodes a 185 kDa transmembrane glycoprotein. • The neu/HER-2 gene product possesses tyrosine kinase activity. • Overexpression in about 30% Ca. Related to resistance chemoth/ , grow and spread more agressively • Treated with HERCEPTIN

  21. IHC of C-ErbB-2/neu/HER-2:

  22. p53 • P53 is tumor suppressor gene which can induce apoptosis after irreparable cell damage and regulates the normal cell growth cycles by activating the transcription of involved gene. • Inactivation or mutation of p53 leads to replication of damaged DNA thus promoting the development of malignant cell clones.

  23. Overexpression of mutant p53 can be detected by IHC. • Overexpression of p53 seems to be related to resistance against certain regimens of endocrine and cytostatic chemotherapy.

  24. IHC of p53

  25. Bcl-2 • bcl-2 is a suppressor of apoptotic cell death. • The expression of bcl-2 is correlated positively with higher estrogen receptor content.

  26. IHC of bcl-2

  27. Ki-67 / MIB-1 • Ki-67 is nuclear protein which is expressed in the S,G2 and M phase of dividing cells. • Expression of Ki-67 is used as an index of proliferative activity in breast cancer. • The presence of <10% low rate, 10-20% intermediate and >20% is • high proliferative rate.

  28. IHC of Ki-67

  29. Conclusions : • Immunohistochemistry is a staining technique for detecting many prognostic factors of breast cancer. • The accurate examination and reporting of standard pathologic features remains very important in the diagnosis and prognosis of women with breast cancer.

  30. THANKYOU

More Related