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CLINICAL CHEMISTRY CHAPTER 30

2. IntroductionCancer is the second leading cause of death in the Unites States

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CLINICAL CHEMISTRY CHAPTER 30

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    1. 5/26/2012 1 CLINICAL CHEMISTRY CHAPTER 30 TUMOR MARKERS

    2. 2 Introduction Cancer is the second leading cause of death in the Unites States … What’s number one? Generally speaking, the sooner it’s detected the sooner treatment can begin and the better the prognosis will be Wouldn’t it be nice if there were relatively simple blood tests that could be used to detect cancers? … Actually, there are … Sort of

    3. 3 Key Terms Cancer Neoplasm Oncofetal proteins Oncogenes Staging Tiumor Markers Tumor – associated antigens Tumor – specific antigens PSA CEA AFP CA125 hCG

    4. 4 Objectives Define what a tumor marker is List the various substances that can be classified as tumor markers Discuss the roles of tumor markers in cancer management List the ideal characteristics of a tumor marker List the common tumor markers that are commonly tested in the clinical laboratory and the malignancies they are associated with

    5. 5 Why are tumors markers important? Cancer is the 2nd leading cause of death in the United States More than 50 documented types of malignancies Common cancers Men : Lung , Prostate , Colon Women : Breast, Lung, Colon, Uterine Overall #1 Lung #2 Prostate #3 Breast

    6. 6 Tumor Markers Tumor markers are biological substances produced by malignant cells or other non – malignant cells in response to a malignancy Tumor markers can differentiate malignant cells from normal cells Tumor markers can be found in Plasma Inside cells On cell membranes Plasma tumor markers can be measured as laboratory tests Cellular tumor markers can be detected with special stains or other special techniques

    7. 7 “Ideal” tumor marker characteristics Sensitive Detectable at low concentrations Sensitive to small or new malignancies Specific Presence of a given marker identifies an exact malignancy Concentration proportional to tumor size ( burden ) Concentration changes with growth or reduction of maligncy Concentration is low after remission ( cure ) Concentration is a good indicator of prognosis Short half – life ( concentration reflects current conditions )

    8. 8 Reality of tumor markers Unfortunately, most tumor markers only possess some of the ideal characteristics ( never all of them ) ! Most tumor markers are not very sensitive and are poor screening tests for the detection of malignancies Most tumor markers are best utilized to confirm or monitor already diagnosed cancers

    9. 9 Tumor specific antigens Specific products of malignant cells Tumor associated antigens Oncofetal antigens - Antigens present in normal fetal growth and stimulated by malignancies later in life

    10. 10 Different types of tumor markers Enzymes Hormones Fetal antigens Proteins Cancer associated antigens Genetic defects

    11. 11 Laboratory techniques for analysis of tumor markers Large variability's Results and normal ranges show poor reproducibility Each lab must establish its own normal ranges to reflect different methodologies EIA techniques are the most common

    12. 12 CEA ( Carcinoembryonic Antigen ) Oncofetal antigen Best tumor marker for monitoring of colon cancer Also elevated in Smokers Alcoholic cirrhosis Ulcerative colitis Not specfcic for colon cancer Good correlation with treatment and prognosis of colon cancer ? CEA after surgical removal of tumor ? CEA if malignancy re-occurs or metastasizes ( spreads ) Levels correlate well with chemotherapy and irradiation treatment

    13. 13 Alpha –Feto - Protein ( AFP ) Oncofetal antigen ( synthesized during normal fetal development ) ? in pregnancy and certain malagnancies Useful tumor marker for monitoring Liver cancer Gonadal malignancies Colon cancer

    14. 14 Prostate Specific Antigen ( PSA ) PSA is a tissue specific enzyme secreted by malignant prostate cells PSA is present in low concentrations of normal males, but elevated in malignancies and other conditions Good screening test for the detection of prostate cancer in older males and the monitoring of previously diagnosed tumors

    15. 15 A FEW OTHER TUMOR MARKERS CA 125 ( Carcinoma Associated 125 ) PROTEIN UTILIZED TO EVALUTE GONADAL ( OVARIAN ) CANCERS CA125 is not efficient in detecting early ( more treatable ) ovarian cancers CA125 is useful in detecting late ovarian cancers and recurrence of cancers False positives may occur, resulting in unnecessary treatment 75 % of ovarian cancers are not diagnosed until late in the disease – 14,000 deaths in 2002

    16. 16 HCG ( Human Corionic Gonadaltropin ) Hormone … Increases in gonadal tumors Ovarian and testicular cancers Same hormone utilized for pregnancy testing CA 15-3 Associated with breast cancer Abnormal plasma proteins Bence Jones Protein ( Multiple Myeloma ) IgM antibody ( Waldenstrom’s Disease )

    17. 17 TOP 10 Tumor Markers - Substances produced by malignant cells or by other non-malignant cells in response to the malignancy Tumor markers can be a variety of substances ( proteins , enzymes , ect ) AFP Liver cancer CEA Colon cancer PSA Prostate cancer HCG Ovarian / Testicular Cancer

    18. 18 Tumor Marker Links

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